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A    MANUAL    OF 
NATURAL    THERAPY 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 
Columbia  University  Libraries 


http://www.archive.org/details/manualofnaturaltOOIuke 


A   MANUAL  OF 

NATURAL  THERAPY 


BY 

THOMAS    D.    LUKE,    M.D,    F.R.C.S.  (Edin.) 

Lcctuj-cr  at  the  University  of  Edinlni>-^h ;  forincrly  Physician  at  Sini'iitcy's  Hyii>'ofiathic  ana 

Sanatoriji7u,  Matlock;   Assistant  Visiting' Physician  Sinedlcy's  Memorial  Hospital; 

Pliysicia)L  to  HazeliLwod  Hycirofiaihic  Establis!i:ncnt,  Grange-ovcr-Sands,  etc. 

Fellow  of  the  British  Balneological  Society ;  Member  of  the  Electro- 

Therapeutic  Society  (Royal  Society  o/  Medicine.) 


WITH   THIRTY   PLATES 

AND    ONE    HUNDRED    AND    TWENTY-FR'E    ILLUSTRATIONS 

MANY    OF    WHICH    ARE    ORIGINAL 


See  the  wondrous  water  streaming, 
Forth  the  fount  of  health  is  steaming, 

Now  rises  higher 

Life's  true  desire, 
Hail  to  water  I     Hail  to  fire  ! 


GOETHE 


willia:m    wood    and    co.mpany, 

MIXXCCVIII. 


JOHN   WRIGHT    AND   SONS   LTD. 
PRINTERS,      BRISTOL 


DEDICATED    BY    PERMISSION 
TO 

WILHELIM    W.    WINTERNITZ,    M.D. 

PROFESSOR    OF    HYDROTHERAPEUTICS    IN    THE    UNIVERSITY    OF    VIENNA, 

TO    WHOM    THE    MEDICAL    PROFESSION    OWES    SO    VERY    LARGELY 

THE    KNOWLEDGE    WHICH    IT    POSSESSES    OF    THE 

SCIENTIFIC    USE    OF    WATER    IN    THE 

CURE    OF    DISEASE 


PREFACE. 

Some  ten  years  ago  the  author  conceived  the  idea  of  writing 
a  book  of  this  character.  A  commencement  was  then 
made,  but  o\\ing  to  an  unexpected  change  of  environment 
and  other  circumstances,  it  was  not  proceeded  with.  During 
the  past  decade  great  progress  has  been  made  in  methods 
of  natural  therapy,  and  particularly  in  the  department  of 
electrical  treatment  and  electro-thermal  methods.  The 
author  feels  that  the  time  has  now  arrived  when  there  is  a 
distinct  want  for  a  book  on  "  Natural  Therapy  "  in  this 
country,  and  he  ventures  to  hope  that  it  may  be  welcomed 
by  the  medical  profession.  In  the  preparation  of  the  work 
no  attempt  has  been  made  to  give  a  complete  or  exhaustive 
account  of  any  of  the  departments  dealt  with,  but  the 
author  has  endeavoured  to  embody  the  chief  points  of 
interest  and  importance,  briefly  and  succinctly,  in  such  a 
manner  as  to  awaken  interest,  and  lead  to  further  study 
and  consideration  of  the  methods  treated  of  on  the  part 
of  the  reader.  A  bibliography  has  been  added  at  the 
end  of  the  book,  and  to  the  authors  of  many  of  the 
volumes  therein  mentioned  the  author  herewith  gratefullv 
acknowledges  his  obligations. 

Throughout  the  text,  footnotes,  marginal  references, 
and  acknowledgments  have  been  intentionalh*  avoided,  as 
embarrassing  to  the  reader  when  frequently  employed.  The 
name  of  an  authority  is  frequently  mentioned  in  brackets. 
In  the  section  on  hydrotherapeutics  it  is  difficult  to  mention 
any  ascertained  physiological  fact  which  we  do  not  owe  to 
the  work  of  Winternitz  or  Kellogg,  and  their  names  occur 
frequently. 

The  encouragement  extended  to  the  author  on  all  hands 
when  help  in  the  production  of  the  book  was  solicited  has 
been  most  gratifying. 


viii  PREFACE 

Thanks  are  especially  due  to  friends  for  hearty  co- 
operation in  illustrating  this  volume,  and  in  particular  to 
Dr.  Kellogg,  of  Battle  Creek  and  the  F.  A.  Davis  Co.,  of 
Philadelphia,  for  the  use  of  Plates  III,  IV,  V,  VIII,  X,  XI, 
XXIV,  and  Fig.  i8  ;  to  Dr.  Cecil  Sharpe,  of  Matlock,  for 
the  loan  of  photographs  and  help  in  various  ways ;  to 
the  Bath  Corporation  for  the  Frontispiece,  Plates  I,  II, 
XII,  XIV,  XV,  and  other  figures  ;  the  Harrogate  Corpor- 
ation for  Plate  XXII  ;  Dr.  Philp  for  Plate  XX  ;  Mr. 
A.  M.  Thiem,  for  Plate  XXI ;  and  to  Mr.  Dowsing  and 
Mr.  H.  E.  Greville  for  figs.  44  and  45,  and  Plates  XIX  and 
XX.  The  author  is  also  similarly  indebted  to  The  Fischer 
Kiefer  Co.,  and  other  manufacturers,  for  the  loan  of 
various  photographs  and  illustrations,  which  have  added 
to  the  clearness  of  the  text. 

Many  illustrations  are  from  original  drawings  by  Dr. 
Georges  Dupuy,  of  London,  and  owe  such  merit  as  they 
possess  to  the  combination  of  his  artistic  skill  and  medical 
knowledge. 

Dr.  W.  T.  Ritchie  has  kindly  gone  over  most  of  the 
proof  sheets,  and  has  made  many  helpful  and  valuable 
suggestions. 

The  author  hnally  expresses  his  obligations  to  the 
publishers  for  their  uniform  courtesy  and  untiring  efforts 
to  give  the  book  every  advantage  so  far  as  illustrations  and 
production  generally  are  concerned.  That  many  imperfec- 
tions remain  in  spite  of  all  the  time  and  care  which  have 
been  expended  the  author  knows  full  well,  but  encouraged 
by  the  favourable  reception  granted  to  previous  ventures, 
he  now  entrusts  the  work  to  "  the  tender  mercies  "  of  the 
reviewer  and  the  medical  public. 

T.  D.  L. 

Edinburgh, 

September,  igo8. 


CONTENTS. 


PREFACE  ...---.  Vll 

FOREWORD  .......  XV 

Section    /.—THE   USE   OF   WATER   IN  THE   TREATMENT 
OF    DISEASE. 

CHAPTER  PAGE 

I.       THE    HISTORY    OF    B.-VTHING       -----  I 

II.  HYDROTHERAPY    ------  lO 

III.  ON    THE    TAKING    OF    BATHS      -----  34 

IV.  THE    TECHNIQUE    OF    COMPRESSES,    PACKS,    POULTICES,    ETC.  56 
V.  THE    NAUHEIM    BATHS                    _                  .                  _                  .                   -  75 

VI.       PEAT,    FANGO,    AND    OTHER    MEDICATED    BATHS  -  84 

Section    //.—HEAT    AND    LIGHT    IN    THE    TREATMENT 
OF   DISEASE. 

VII.       THERMOTHERAPY     ------  94 

VIII.       HOT-AIR,    STEAM,    AND    TURKISH    BATHS  -  -  -    .  II5 

IX.       PHOTOTHERAPY     ------  122 

Section    ///.— M-\SSAGE,    Etc.,    IN   THE   TRE.\TMENT 
OF    DISEASE. 

X.       MASSOTHERAPY  -  -  -  -  -  -  134 

XI.       THE    REST    CURE    -.-.--  1 52 

Section    /F.— ELECTRICITY    IN    THE    TREAT.MENT 
OF    DISEASE. 

XII.       GALVANISM    .\ND    FARADISM     -  -  -  -  -  I  58 

Mil.       SINUSOIDAL     CURRENTS HYDRO-ELECTRIC     BATHS ST.-VTIC 

ELECTRICITY  .  .  -  -  .  2O4 

.XIV.       HIGH-FREQUENCY  CURRENTS    -  .  -  -  -  2l8 


CONTENTS 


Section    F.  — DIET    IN    THE    TREATMENT    OF    DISEASE 

CHAPTER  PAGE 

XV.       GENERAL    PRINCIPLES    AND    COMPOSITION    OF    FOOD                  -  229 

XVI.       DIET    IN    HEALTH    AND    IN    THE    INDIVIDUAL      -                   -  242 

XVII.       DIET    IN    DISEASE         ------  249 

XVIII.       SPECIAL    DIET    CURES       -                   -                   -                   -                   -  265 

Sectiori    F/.— THE   MODERN    -  CURE." 

XIX.       HYDROP.\THIC    AND    "CURE"    ESTABLISHMENTS                          -  278 

XX.       FOREIGN    MINERAL    WATERS          -                   -                   -                   .  284 

BIBLIOGRAPHY  -------  290 

INDEX              -                          .             _             .             .             .  296 


LIST     OF     PLATES. 


Frontispiece. — The  Grand  Pump  Room,  Bath,  iSth  Century 
{after  Rowlandson.) 

Plate  I. — The  King's  Bath  (at  Bath),  i8th  Century 
{after  Rowlandson.) 

Plate  II. — The  Old  Roman  Bath  (at  Bath)  restored 

Plate  III. — The  Battle  Creek  Sanitarium       -  -  - 

Plate  I\'. — Arm,  Foot,  and  Leg  Bath  .  .  .  . 

Plate  V.— The  Sitz  Bath       ------ 

Plate  VI. — General  Bath  Room         ----- 

Plate  VII. — Back  Laving  or  Sponging  -  -  -  - 

Plate  VIII. —Half  Bath  with  Affusion  -  -  - 

Plate  IX. — Half  Bath  with  Friction  -  -  -  - 

Plate  X. — Broken  Horizontal  Jet  Douche     -  -  -  - 

Plate  XI. — Horizontal  Percussion  Douche  -  -  - 

Plate  XII. — The  Circle  Douche  Bath  .  .  .  - 

Plate  XIII. — The  Aix  Douche  ----- 

Plate  XIV. — Special  Douche-Massage  Chair  .  -  - 

Pl.ate  X\'. — Douche  Massage  of  Abdomen    -  -  -  - 

Plate  XVI. — Vichy  Douche  with  three  Sprays       -  -  - 

Plate  XVII. — The  Fischer  Kiefer  CO.,  Generator  for  the  Xauheim 
Bath  -  .  .  -  . 

Plate  XVIII. — The  Application  of  Fango  -  -  -  - 

Pl.\tes  XIX,   XX. — Greville  Electro- thermic  Generators 

Plate  XXI. — Turkish  Bath — "  The   Calidarium  "    - 

Plate  XXII. — Turkish  Bath — The  Cooling  Room    - 

Plate  XXIIL— The  Sunlight  Bath— Open-air  (Peebles),  and  Indoor 

Plate  XXIV.— Sand  Bath  at  Battle  Creek 

Plate  XXV.— The  Electric-Light  Bath        -  .  -  - 

Plate  XXVI. — The  D' Arson val-Gaiffe  Installation 

Plate  XXVIL— Electric  INIassage     ----- 

Plate  XXVIIL— The  Schnee  4-Cell  Bath   -  -  -  - 

Plate  XXIX. — The  "  Ergos  "  Static  Machine 

Plate  XXX. — High-Frequency  Installation  .  -  - 


3 

4 

36 

40 
41 
44 
45 
45 
52 
53 
53 
54 


76 
86 
114 
118 
119 
124 

1^5 
12S 
161 
202 
209 

-13 
219 


LIST     OF     ILLUSTRATIONS. 

FIGURE  PAGE 

i.^ — John  Smedley       ------  g 

2. — Pulse  Tracing  after  Cold  Applications   -             -             -  i8 

3. — Pulse  Tracing  after  Hot  Applications    -             -             -  19 
4-5. — Cutaneous  Areas  refiexly  associated  with  Internal 

Parts  (2  Figs.)  -  -  -  -  -       22,  23 

6. — Cutaneous  Areas  reflexh^  associated  with  Visceral 

Pain      -             -             -             -             -             -             -  25 

7. — An  Adjustable  Gravity  Syringe  -              -              -              -  31 

8. — Rectal  Irrigator   -             -             -             -             -             -  32 

9. — Winternitz'  Urethral  Psychrophore          -              -              -  ^^ 

10. — An  Improved  Foot  Bath              -             -             -             -  36 

II. — An  Improved  Leg  Bath                -              '              -              -  39 

12. — Sitz  Bath,  with  Friction               -              -              -              -  41 

13. — Modern  Type  of  Set-in  Bath       -              -              -              -  45 

14. — Pulse  Tracing  before  and  after  Full  Bath              -              -  47 

15-17. — The  Drip  Sheet  (3   Figs.)  .  .  .  -       48,  49 

18. — Horizontal  Douche            -             -             -             -             -  51 

19. — Kellogg's  Nozzle                -             -             -             -             -  52 

20. — Rose  for  Spray  Douche  -              -              -              -              -  52 

21. — Pulse  Tracing  before  and  after  Spray  Bath      -             -  53 

22. — The  Aix  Douche  with  Two  Attendants               -             -  54 

23. — Pulse  Tracing  before  and  after  Vichy  Douche                -  55 

24. — Head  Compress    ------  59 

25. — Throat  Compress               -----  g^ 

26-27. — Compress  for  Tonsils  and  Pharynx  (2  Figs.)           -              -  60 

28. — The  Chest  Compress         -----  61 

29. — Compress  for  the  Trunk               -             -             -             -  62 

30. — Joint  Compress    ------  63 

31. — Electro-thermal  Compress             -             -             -             -  64 

32. — The  Compresses  applied                 -              -              -              -  64 

33. — Application  of  Wet  Pack             -             -             -             -  6^ 

34. — The  Wet  Pack  complete               -              -              -              -  66 

35. — The  Dry  Pack      ------  67 

36. — Electric  Sweating  Mattress           -             -             -             -  67 

37-38- — Ice  Compresses  (2  Figs.)  -  -  -  .      73,  74 

39. — Patient  in  the  Nauheim  Bath    -             -             -             -  77 


LIST     OF     ILLUSTRATIONS  xiii 

FIGURE  I'AGE 

40. — Cardiac  Dullness  as  affected  by  Nauheim  Baths  -  78 
41. — Pulse  Tracing  before  and  after  Course  of     Nauheim 

Baths       -------  79 

42. — Diagram  of  the  Spectrum  showing  Dowsing's  Rays  -  97 

43. — Chart  showing  Thermometric  Equivalents          -  -  103 

44. — Dowsing  Luminous  Heat  Apparatus       -             -  -  no 

45. — Direct  Radiator  applied  to  Back  of  the  Neck  ■  in 

46. — Local  Radiant-Heat  Cabinet       -             -             -  -  113 

47. — Hot-Air  Cabinet  -             -             --             -  -  115 

48. — The  Steam  Cabinet  Bath              -              -              -  -  117 

49. — Vertical  Electric-Light  Cabinet                -             -  -  127 

50. — Horizontal  Electric-Light  Cabinet           -             -  129 

51. — Effieurage  carried  out  with  the  Finger  Tips      -  -  137 

52. — Petrissage  with  Thumb  and  Finger        -              -  -  137 

53. — Petrissage  of  Forearm  with  Both  Thumbs         -  -  138 

54. — Tapotement  with  Dorsal  Surface  of  Hand         -  -  138 

55.— Hacking    -              -              -              -              -              -  -  I39 

56. — Petrissage  with  Vibratory  Movement     -              -  -  140 

57. — Effleurage  performed  with  the  Entire  Palm  -  141 

58. — Rotation  of  the  Forearm  Muscles            .              .  -  142 

59. — Massage  of  the  Stomach              .             .             -  .  j^^ 

60. — Massage  of  the  Abdomen             _             .             .  .  144 

61. — Massage  of  the  Abdomen             -             -             -  -  145 

62. — The  "  Ruk  "  Vibrator  in  use      -              -              -  .  149 

63. — The   "  Barker  "   Vibrator               -              -              -  -  150 

64. — Common  Form  of  Acid  Cell        -              -              -  -  163 

65. — lO-Cell  Bichromate  Battery         -              -              -  -  154 

66.— Dry  Cell  -              -              -              -              -              -  -  165 

67. — Crank  Collector    ------  166 

68-69. — Placing  of  Crank  (2   Figs.)           -              .              .  .  igg 
70. — Double  Crank  Collector  -             -             -             -  -  167 
71. — Combined  Continuous  and  Alternating  Current  Switch- 
board      -              -              -              -              -              -  -169 

72-73. — Metal  Rheostats  (2  Figs.)             -             .             .  .  171 

74. — Series  Resistance               -             -             -             -  -  172 

75. — High-Tension  Transformer            -              -              -  -  ^73 

76. — Motor  Transformer           -             -             -             -  -  '^73 

77. — Diagram  to  show  Short  Circuit  in  Bath             -  -  175 

7S. — Open  Gully  for  Waste  Pipe        -             -             -  -  175 

79. — Switch-board  for  Galvanism,  etc.             -              -  -  176 

80. — Diagram  of  Switchboard,  with  Lamp  and  Resistance-  177 


LIST     OF     ILLUSTRATIONS 


PAGE 


8 1. — D'Arsonval  Galvanometer             -             -             -  -  178 

82. — Combined  Electrode  and  Galvanometer              -  -  178 

83. — Plan  of  Shunt  Circuit      -             -             -             -  -  180 

^4. — Voltmeter              -             -             -             -             -  -  180 

85. — Current  Reverser               -             -             -             -  -  181 

86. — Current  Alternator            -             -             -             -  -  182 

87-91. — Various  Forms  of  Electrodes  (5   Figs.)  -             -  -  183 

92. — Galvanic  Battery  with  Collector  and  Commutator  -  187 

93. — Spamer's  Coil       ------  189 

94. — Lewis  Jones'  Sledge  Coil              -             -             .  -  igQ 

95. — Scheme  of  Galvano-Faradic  Battery      -             -  -  191 

96. — Diagram  showing  the  production  of  Induced    Currents  191 

97. — Movent's  Sledge  Coil        -             -             -             -  -  192 

98. — Diagram  showing  Regulation  of  Secondary  Current  -  197 

99. — The  Wagner  Hammer      -             -             -             -  -  198 

100. — Du  Bois  Raymond's  Sledge  Coil              -             -  -  200 

loi. — Curve  of  Sinusoidal  Current        -              -              -  -  204 

102. — Curve  of  Secondary  Faradic  Current      -              -  -  204 

103. — Diagram  of  Armature  Winding                 .              .  .  205 

104. — Sinusoidal  Curve  -----  205 

105. — Tri-phase  Currents  -----  205 

106. — Transformer,  etc.,  for  Tri-phase  Currents           -  -  206 

107. — Herschell-Dean  Sinusoidal  Apparatus     -             -  -  207 

108. — Commutator  for  a  4-Cell  Schnee  Bath                 -  -  209 

109. — Diagram  showing  Path  of  Current          -              -  -  210 

no. — Newton's  Static  Machine  in  Case            -             -  -  213 

111-116 — Various  Electrodes         -             -             -             -  -  215 

117. — Massage  Roller  Electrode             -             -             -  -  216 

118. — The  D'Arsonval  Transformer      -             -             -  .  218 

119. — The  Oudin  Resonator      -              -              -              -  -  219 

120. — High-Frequency  Apparatus  on  Trolley,  complete  -  221 

121. — High-Frequency  Apparatus  with  Oil  Condenser  -  222 

122. — Vacuum  Condensing  Electrodes               .             .  -  223 

123. — Portable  High-Frequency  Apparatus       -             -  -  224 

124. — Hot  Wire  Milliamperemeter         -             -             -  -  225 

125. — Pulse  Tracing  after  H.F.  Treatment       -             -  -  227 


FOREWORD. 

Medicine  has  ever  been  subject  to  fashions  ;  though  it 
must  be  at  once  admitted  that  some  of  the  changes  which 
have  taken  place  in  the  methods  of  treatment  and  combat- 
ing disease  during  the  past  twenty-five  years  are  to  be 
attributed  to  something  other  than  mere  fashion. 

There  are  always  seasons,  we  must  allow,  when  some 
special  drug  or  method  of  treatment  is  run  to  death.  The 
antipyretic  coal-tar  derivatives  in  the  treatment  of 
influenza,  the  "  old  tuberculin  "  for  phthisis,  the  intra- 
tracheal injection  of  menthol  oil,  the  cacodylates,  and 
lastly  the  formates — these  may  be  mentioned  as  some  of 
the  comparatively  recent  fashions  in  medicine,  and  if  we 
except  the  formates,  they  have  had  their  day  and  for  the 
most  part  died  a  natural  death.  The  formates  still  linger 
with  us. 

The  changes  referred  to  above,  however,  are  more  radical 
and  lasting  in  character,  and  depend  largely  on  improved 
methods  of  diagnosis  and  surgical  technique,  and  a  lasting 
reaction  against  empiricism.  Drugs  are  now  much  less 
freely  prescribed  both  in  good-class  practice  and  in  hospital. 
Going  round  a  medical  ward  one  cannot  help  being  struck 
by  the  absence  of  long  prescriptions,  once  so  common,  on 
the  patient's  bed-card.  These  are  now  seldom  seen.  There 
is  the  chart  with  respiration  and  pulse-rate,  the  temperature, 
blood-count,  etc.,  and  possibly  away  in  the  corner,  in  very 
small  writing,  "  Haematogen  3  j  t.i.d.,"  or  "  Nuclein  gr.  ij," 
or  '*  Thyroidectin  gr.  v."  On  all  the  cards  the  British 
Pharmacopoeia  takes  a  minor  place. 

Again,  at  one  bed  we  see  a  man,  with  a  pallid,  puffy  face, 


xvi  FOREWORD 

lying  in  a  bed  vapour  bath  ;  at  another  an  electrician  is 
galvanizing  a  case  of  exophthalmic  goitre  from  "  the  main  "  ; 
and  as  we  leave  the  ward  we  notice  a  fair-haired  Norseman 
enter,  and  are  told  that  he  is  the  masseur,  who  pays  a 
daily  visit. 

The  explanation  is  not  far  to  seek.  While  in  club  and 
country  practice  it  is  often  difficult  or  impossible  to  do 
without  a  liberal  supply  of  B.P.  drugs,  still  the  modern 
physician  does  his  best  to  cure  such  cases  as  the  present-day 
surgeon  leaves  him,  by  stimulating  by  natural  methods  of 
treatment  the  vis  medicatrix  naturcB — always  present,  if 
often  sluggish — and  further,  wherever  possible  he  prescribes 
specific  treatment,  and  promotes  the  general  good  health 
of  the  patient  by  suitable  diet  and  hygiene.  The  physician 
is  quick  to  recognize  where  his  limit  is  reached,  and  to 
hand  over  to  a  surgeon  the  patient  suffering  from  a 
surgical  affection. 

The  value  of  many  drugs  is  recognized,  and  they  have 
their  place,  but  polypharmacy  is  at  a  discount.  The  use 
of  sera,  vaccines,  and  animal  extracts  of  various  kinds 
is  increasing,  and,  where  these  fail  or  are  unsuitable, 
natural  therapy  is  increasingly  employed.  H^^drotherapy, 
massage,  electricity,  and  special  diets  are  now  freely  pre- 
scribed every  day.  That  their  use  is  based  on  sound 
principles,  and  that  they  are  not  a  passing  craze,  the 
following  pages  may  help  to  show. 


NATURAL  THERAPY. 


Section    I. —  The    Use    of    M^ater    in    the 
Treatment   of  Disease. 


CHAPTER  I. 
THE   HISTORY   OF   BATHING. 

'T^O  the  medicinal  use  of  baths  allusion  is  frequently 
-^  made  in  Greek  mythology.  Homer  speaks  of 
Andromache  preparing  the  bath  of  Hector,  and  of 
Penelope's  use  of  baths  and  unguents  to  allay  the 
melancholy  which  her  husband's  prolonged  absence  caused 
her.  Again,  mention  is  made  of  the  weary  Hercules  being 
refreshed  and  strengthened  by  Minerva  at  the  springs 
of  Thermopylse.  The  beneficial  effect  of  warm  bathing 
on  old  people  suffering  from  what  we  now  call  "  Anno 
Domini "  was  recognized  at  a  remote  period.  Ulysses 
returning  from  Ithaca  found  his  aged  father  Laertes 
in  a  condition  of  great  weakness,  and  we  are  told  he 
advised  warm  bathing,  and  spoke  of  one  who,  worn  out  and 
emaciated  by  age,  by  the  use  of  baths  regained  health  and 
appetite.      Such  was  the  common  custom  among  old  men.* 

Hippocrates  mentions  the  use  of  warm  baths  in  fevers, 
and  the  use  of  hot  springs  and  of  watery  and  balsamic 
vapours.  Plato  refers  to  the  value  of  baths  in  various 
diseases. 

Sulphurous  baths  were  advised  by  Aretaeus  for  the  cure 
of  melancholy  and  leprosy  ;  this  writer  was  the  first  to 
recommend  the  exclusion  of  the  head  in  vapour  baths — 
a  valuable  observation.  Cold  baths  in  the  treatment  of 
fevers  were  recommended  by  Galen  and  Celsus,  the  former 

*  Odyssey,    xxiv. 


2  NATURAL    THERAPY 

emphasizing  their  value  in  the  combating  of  hyperpyrexia. 
Subsequent  writers,  such  as  Pontus  iEgineta  (celebrated 
as  a  physician  in  the  7th  century)  and  Oribasius,  developed 
the  theory  of  balneotherapy  and  extended  its  use. 

By  the  use  of  pure  water  in  the  treatment  of  malignant 
dysentery  in  Holland,  in  the  17th  century.  Van  der  Heyden 
foreshadowed  the  methods  which  became  systematized, 
early  in  the  19th  century,  by  Priessnitz  and  others  under 
the  term  "  Hydropathy,"  signifying  the  treatment  of 
disease  by  the  inward  and  outward  applications  of  water. 
In  1702,  Sir  John  Floyer,  a  Lichfield  physician,  published 
his  "  History  of  Cold-bathing,  both  Ancient  and  Modern," 
which  ran  through  no  less  than  six  editions  within  a  few 
years,  and  was  translated  into  German  by  Dr.  J.  S.  Hahn,  of 
Silesia,  who  was  himself  a  strong  advocate  of  the  hydro- 
pathic treatment  of  small-pox,  at  that  period  such  a  scourge. 

In  the  year  1747,  the  Rev.  John  Wesley,  founder  of 
the  Methodist  Connexion,  published  a  small  treatise 
entitled  "  Primitive  Physic,"  which  gives  evidence  of  the 
existence  at  that  period  of  a  very  considerable  acquaint- 
ance with  the  remedial  and  hygienic  value  of  water 
[Plates  I  and  II).  All  the  measures  recommended  Wesley 
declares  he  found  useful  and  curative  among  the  people 
with  whom  his  evangelistic  work  brought  him  in  contact. 
Such  varied  ailments  as  ague,  apoplexy,  cholera  morbus, 
and  mania  were  dealt  with,  and  cold-water  baths  or 
applications  were  used  in  the  vast  majority  of  cases. 
Even  so  great  an  authority  as  Dr.  Kellogg  remarks  at  the 
present  day,  "  One  cannot  help  noting  the  sagacity  and 
wisdom  displayed  in  many  of  the  recommendations,  which 
in  numerous  instances  could  scarcely  be  improved  upon  in 
modern  times,  and  which  certainly  evince  extended  and 
accurate  observation  of  the  effect  of  hydriatic  procedures." 

Further,  Dr.  Currie,  of  Liverpool,  published,  in  1797, 
"  Medical  Reports  on  the  Effect  of  Water,  Cold  and  Warm, 
as  a  Remedy  in  Fevers  and  other  Diseases."  This  manual, 
which  was  widely  read  in  this  country,  placed  the  subject 
on  a  more  scientific  basis,  and  was,  like  Floyer's,  translated 
into  German.  Meantime  much  enthusiasm  had  been  evoked 
among  his  countrymen  by  Hahn's  writings,  and  many 
societies  were  established   to  promote   the  medicinal   and 


PLA  TE     I. 


The    King's    Bath    (at    Bath)    i8th    Century   (after   Rowlandson's   Sketch). 


'Twas  a  glorious  sight  to  behold  tlu-  lair  ■^ex  In  a  great  smoking  kettle  as  big  as  our  hall. 

All  wading  with  gentlemen  up  to  their  neeks,         Every  day  many  persons  of  rank  and  condition 
And  view  them  so  prettily  tumble  and  sprawl,         Were  boil'd  by  command  of  an  able  phj'sician"- 


THE     HISTORY     OF     BATHING  3 

dietetic  uses  of  water.  Boerhave  and  Heberden  were 
both  interested  in  this  movement,  and  freely  prescribed 
bathing  of  various  kinds.  In  1804  Professor  Oertel  gave 
the  water-cure  a  fresh  impetus  by  his  unquahfied  com- 
mendation of  water-drinking  as  a  sovereign  remedy  for 
all  manner  of  diseases. 

The  actual  birth  of  systematic  hydropathy,  however, 
may  be  said  to  date  from  1829,  when  Vincenz  Priessnitz 
(1801-51),  a  farmer  of  Grafenberg  in  Silesia,  began  his 
public  career  on  the  paternal  homestead,  which  he  enlarged 
to  accommodate  the  numerous  patients  attracted  by  the 
fame  of  his  cures.  This  extraordinary  man,  when  seventeen 
years  of  age,  met  with  an  accident  resulting  in  numerous 
bruises  and  the  fracture  of  two  ribs,  with  such  complica- 
tions that  the  physicians  who  were  called  in  gave  him  no 
hope  of  recovery.  Being  in  this  poor  case,  Priessnitz  called 
to  mind  the  benefit  which  he  found  his  animals,  when 
injured,  derived  from  being  treated  with  water  applications, 
and  he  forthwith  determined  to  resort  to  the  same  remedy 
for  himself.  He  applied  wet  compresses  to  the  injured 
region,  and  at  the  same  time  drank  water  freely,  with  the 
result  that,  whether  post  or  propter  hoc,  he  was  very  shortly 
quite  restored  to  health.  This  happy  issue  made  such  a 
profound  impression  on  his  peasant  mind  that  he  resolved, 
so  far  as  he  was  able,  to  make  a  complete  investigation 
of  the  remedial  powers  of  water,  used  internally  and 
externally.  Guinea-pigs  had  not  at  that  time  attained 
their  present  pre-eminence  in  experimental  science,  and 
Priessnitz  began  his  researches  on  two  ordinary  porkers. 
He  fed  one  on  hot  and  the  other  on  cold  foods,  and  on 
killing  them  later,  made  a  thorough  examination  of  their 
intestines,  when  he  discovered,  as  he  affirmed,  that  the  gut 
of  the  animal  fed  on  cold  foods  was  contracted,  pale,  and  of 
firm,  resistant  character,  while  the  intestines  of  the  pig  fed 
on  hot  food  were  red  and  relaxed,  and  so  friable  as  to  be  use- 
less for  the  making  of  sausages.  The  methods  adopted  by 
Priessnitz  were,  naturally,  crude  in  the  extreme,  but  the 
working  basis  of  his  system  was  the  production  of  perspira- 
tion and  the  subsequent  application  of  cold  water.  Natural 
sagacity  soon  led  him  to  discover  how  variously  different 
people  reacted  to  cold  applications,  and  he  soon  made  a 


4  NATURAL     THERAPY 

practice  of  always  noting  carefully  how  each  patient  reacted 
to  the  first  application,  and  regulating  his  subsequent 
treatment  accordingly.  He  succeeded  in  calling  attention 
to  the  efficacy  of  various  simple  methods  of  applying  water 
which  had  previously  been  quite  unappreciated. 

To  Priessnitz,  pure  empiricist  though  he  was,  is  un- 
questionably due  the  credit  of  formulating  a  complete 
system  of  hydropathy.  Among  people  of  every  rank  whom 
he  attracted  to  Grafenberg  were  numerous  medical  men, 
some  being  drawn  by  curiosity,  others  by  thirst  for  know- 
ledge, but  the  major  portion  by  a  hope  of  a  cure  for  ailments 
which  had  as  yet  proved  unyielding  to  drugs.  Records  of 
experiences  at  Grafenberg  were  published,  some  enthusiastic 
in  their  estimates  of  Priessnitz's  genius  and  acumen,  and 
all  more  or  less  substantiating  his  claims.  These  constitute 
the  only  available  account  of  his  work  and  practice,  for 
Priessnitz  himself  never  expressed  his  views  in  writing. 

In  1840  hydropathy,  in  the  guise  of  the  Priessnitz  system, 
was  brought  back  to  England  and  popularized  by  a  Captain 
Claridge,  whose  book,  "  The  Cold  Water  Cure,"  passed 
through  nineteen  editions  in  as  many  months.  He  further 
delivered  popular  lectures  on  the  subject,  and  made 
numerous  converts.  Dr.  Gully  (the  father  of  the  late 
Speaker)  and  Drs.  Wilson  and  Edward  Johnson  joined 
in  the  movement,  and  large  establishments  at  Malvern 
and  Ben  Rhydding  were  soon  filled  to  overflowing.  The 
craze  spread  even  to  America,  where  large  hydropathic 
"  Sanitaria  "  were  opened. 

The  Battle  Creek  Sanitarium  {See  Plate  III)  is  one  of  the 
best  known  of  these,  and  has  now  attained  gigantic  pro- 
portions. In  it  are  employed  no  fewer  than  a  thousand 
servants,  nurses,  and  attendants,  controlled  by  over  a  score 
of  physicians.  These  minister  to  the  needs  of  upwards  of 
a  thousand  patients.  This  huge  establishment  was  reduced 
to  ashes  in  1902,  but  was  at  once  rebuilt  on  a  larger  scale. 
Its  extraordinary  development  and  success  is  chiefly  due  to 
the  genius  and  enthusiasm  of  Dr.  J.  H.  Kellogg,  the  head 
physician. 

The  literature  of  this  period  of  the  water-cure  is,  as 
might  be  expected,  somewhat  polemical.  The  wildest 
optimism    prevailed    among    the    disciples    of    Priessnitz ; 


THE     HISTORY     OF     BATHING  5 

they  firmly  believed  and  asseverated  that  in  water  and 
in  water  alone,  when  properly  applied,  existed  a  certain 
cure  for  all  the  ills  that  flesh  is  heir  to.  The  innova- 
tion was  a  very  natural  reaction  against  the  wholesale 
bleeding  and  purging  which  constituted  the  practice  of 
the  "  allopathic  "  physicians  of  the  time,  but  it  was  not 
to  be  expected  that  these  more  orthodox  practitioners 
would  welcome  the  movement  or  be  readily  converted. 
On  the  contrary,  the  allopaths  condemned  the  water-cure 
roundly,  and  regarded  the  hydropathists  as  crazy  fanatics. 
The  hydropathists  heaped  condemnation  and  abuse  equally 
freely  on  the  "  man  of  blood  "  and  pompous  prescriber  of 
"  blue  pills." 

A  wild  period  of  controversy  and  antagonism  ended  in 
a  legal  prosecution.  This  resulted  in  a  Royal  Commission, 
which  had  the  effect  of  rendering  Priessnitz  and  his  system 
only  more  popular  and  favoured  by  the  public  than  before. 
Hitherto  some  timidity  had  been  manifested  in  employing 
the  new  method  on  enfeebled  patients  who  were  plainly 
seriously  ill.  The  water-curers  had  concerned  themselves 
mainly  with  the  more  robust  types  of  malades  imaginaires 
(as  undoubtedly  many  of  the  cured  ones  were),  and  gouty 
folk,  who  were  in  a  condition  to  withstand  not  only  a 
very  severe  regimen  but  also  a  severe  "  crisis,"  *  were 
allowed  to  run  its  course  without  restriction. 

A  Derbyshire  manufacturer,  John  Smedley,  of  Lea, 
near  Matlock,  was  the  first  to  observe  the  need  for  an 
adaptation  of  the  cure  to  the  feebler  folk  and  a  tempering 


*  The  crisis  was  a  peculiar  method  of  treatment  which  Priessnitz 
himself  devised.  The  term  we  owe  to  Hippocrates,  as,  applied  to 
the  critical  termination  of  any  acute  disease.  Priessnitz  found  that 
the  repeated  application  of  wet  compresses  to  restricted  skin  areas 
of  patients  suffering  from  various  morbid  conditions  tended  to  give 
rise  to  a  skin  eruption,  beginning  in  a  papular  form  and  going  on  to 
the  formation  of  pustules  and  the  free  discharge  of  green  and  yellow 
pus.  The  discharge  was  encouraged  and  continued  for  some  weeks 
or  even  months,  but  sooner  or  later  gave  place  to  a  simple  serous 
discharge,  and  finally  ceased  altogether.  With  the  healing  of  the 
inflamed  area  of  skin  the  patient  appeared  to  have  regained  his 
health  in  many  cases,  or  only  required  a  little  tonic  treatment  or 
change  of  air  to  completely  restore  him.  From  a  perusal  of  the 
earlier    hydropathic    literature,    and    a    personal   observation   of    a 


6  NATURAL     THERAPY 

of  the  methods  for  "  the  shorn  lamb."  This  worthy 
gentleman,  melanchohc  and  out  of  health,  went  to  Ben 
Rhydding  in  1852,  and  there,  in  his  own  person,  "  tholed 
his  assize  "  of  the  cold-water  cure.  He  was  fully  impressed 
with  its  severities  as  well  as  its  benefits  by  a  six  weeks' 
course,  and  returning  cured,  if  chastened,  to  Matlock,  there 


Fig.  I. — John  Smedley. 


established  and  practised  among  his  employees  a  milder 
form  of  hydropathy.  Commencing  with  a  mere  cottage 
on  the  hillside,  he  soon  enlarged  his  borders  and  founded 
an  establishment  which  was  a  counterpart  of  Priessnitz's 
at    Grafenberg.     Modified   as    Smedley 's    system    was,    his 


number  of  cases  in  1 894-1 895  the  author  is  compelled  to  admit 
that  in  some  cases  of  gout,  rheumatism,  and  chronic  gastritis, 
benefit  was  derived.  The  modus  operandi  is  obscure,  for  it  is  not 
merely  counter-irritation.  The  argument  of  the  hydropathist  was 
that  when  a  vicious  circle  existed,  the  chain  was  broken  by  this 
curious  treatment,  and  also  a  free  discharge  of  morbid  materials 
(humours)  took  place  through  the  crisis.  It  is  noteworthy  that  in 
really  healthy  or  merely  neurotic  people,  it  was  usually  impossible 
to  produce  a  crisis.  The  method  has  now  been  practically 
abandoned.  It  required  the  utmost  patience  and  endurance  on  the 
part  of  the  invalid,  and  caused  many  sleepless  nights,  owmg  to  the 
intense  itching  of  the  crisis  area.  Further,  in  many  cases  it  was 
quite  useless,  and  in  others,  where  milder  measures  might  have 
succeeded,  so  reduced  the  patient  as  to  put  recovery  beyond  hope. 


THE     HISTORY     OF    BATHING  7 

regime  was  severe  enough,  if  one  is  to  believe  the  accounts 
of  those  who  experienced  his  treatment  in  their  own  persons. 
He  unquestionably  did  a  great  deal  of  good  to  a  large 
number  of  people  and  a  good  deal  of  harm  to  not  a  few, 
as  must  ever  be  the  case  when  a  quasi-medical  free  lance 
treats  invalids  indiscriminately,  without  having  had  the 
necessary  technical  training.  There  are  many  people  still 
alive  who  tell  one  most  earnestly  that  they  owe  their  lives 
to  John  Smedley  and  his  system,  and  the  huge  and  flourish- 
ing establishment  which  is  now  to  be  seen  on  the  arena 
of  Smedley's  early  triumphs  and  failures  bears  eloquent 
and  convincing  testimony  to  there  being  at  least  "  method 
in  his  madness,"  and  suggests  that  there  is  something  in 
"  the  water-cure,"  be  it  hot  or  cold. 

Handicapped  as  hydropathy  or  hydrotherapy  was  for 
many  years  by  the  gross  ignorance,  the  insane  optimism, 
and  blatant  self-advertisement  of  the  majority  of  its 
advocates,  it  has  finally  survived  and  emerged  as  a 
recognized  and  valued  curative  method.  The  founding 
of  a  school  of  scientific  hydropathy  by  Winternitz  at 
Vienna  has  done  much  to  establish  it  in  its  proper  place 
in  legitimate  if  not  entirely  orthodox  therapeutics,  and 
elevated  it  far  above  the  level  of  empiricism.  It  may  with 
truth  be  said  that  to  Winternitz  the  medical  profession 
owes  nearly  all  that  it  has  learnt  of  the  scientific  application 
of  water  in  the  cure  of  disease.  He  has  developed  hydro- 
therapy on  scientific  and  physiological  lines,  with  truly 
remarkable  results. 

Beginning  in  1862  with  a  small  establishment  at 
Kaltenleutgeben,  with  accommodation  for  only  a  score 
of  patients,  in  1896  he  was  dealing  with  no  less  than  2000 
invalids.  A  Chair  of  Hydrotherapeutics  was  founded  in 
the  University  of  Vienna,  to  which  he  has  been  appointed, 
and  a  clinic  established  in  this  subject  at  the  General 
Hospital.  Winternitz  has  demonstrated  the  importance 
of  the  primary  action  of  water  on  the  central  nervous 
system  and  its  secondary  antithermic  action  in  fevers, 
and  how  it  can  aid  nature  in  combating  toxaemia  by 
stimulating  the  circulation  and  nervous  system  and  aiding 
in  the  oxidation  and  elimination  of  toxic  products.  His 
doctrines  are  now  almost  universally  accepted,  and  students. 


8  NATURAL    THERAPY 

qualified  and  unqualified,  have  flocked  to  his  clinics,  while 
surgeons  and  orderlies  in  the  Austrian  Army  are  regularly 
sent  to  him  for  training  and  instruction. 

Other  workers  in  the  field  have  been  Brand,  of  Stettin, 
Jurgensen,  of  Kiel,  and  Liebermeister,  of  Basel,  who  be- 
tween the  years  i860  and  1870  employed  the  cooling  bath 
in  typhoid  fever  with  results  which  were  indeed  striking. 
Barr,  Caley,  and  American  physicians  such  as  Kisch 
Baruch,  and  Kellogg  have  confirmed  their  observations 
more  recently,  and  shown  the  extreme  value  of  the  cold 
bath  in  reducing  the  mortality  of  typhoid  and  in  the 
treatment  of  any  hyperpyrexia. 

In  1843  Scoutellen,  who  was  sent  to  German}^  by  Marshal 
Soult  to  study  the  new  treatment,  on  his  return  gave  such 
favourable  accounts  of  the  method  that  hydrotherapy 
soon  grew  into  favour  with  French  physicians,  and  has  so 
remained.  Charcot  was  one  of  the  best-known  exponents, 
using  balneotherapy  largely  in  his  practice  with  the  most 
happy  results.  There  has  indeed  been  a  marked  contrast 
between  the  type  of  hydropathist  in  France  and  Germany, 
for  in  the  latter  country  the  unqualified  and  empirical 
"  water  doctor  "  has  been  the  more  common  type.  This 
is  largely  due  to  the  influence  at  an  earlier  date  of 
Priessnitz,  who  popularized  hydropathy  in  the  teeth  of 
the  opposition  of  the  medical  profession. 

Scattered  all  over  Germany  are  "  Kaltwasser  Kuran- 
stalten,"  originally  established  by  cobblers,  tailors,  and 
other  humble  tradesmen,  whom  the  success  of  Priessnitz 
stirred  to  imitation.  The  law  has  stepped  in  and  put  a 
stop  to  a  great  deal  of  this  irregular  practice,  but  much 
still  goes  on,  the  lay  practitioner  being  "  covered  "  by  some 
qualified  medical  man. 

A  few  years  back  a  great  stir  was  made  by  a  Bavarian 
priest  named  Sebastian  Kneipp,  who  was  entrusted  with 
the  cure  of  souls  at  Worishoven.  This  individual  founded 
a  system  of  his  own — "  the  Kneipp  cure  " — which  con- 
sisted in  cold-water  bathing,  spare  diet,  and  the  use  of  herb 
simples.  He  published  a  small  brochure  on  the  subject, 
"  Mon  Testament,"  embodying  his  principles,  and  treated 
many  thousands  of  patients  annually,  with  varying 
results. 


THE    HISTORY     OF    BATHING  9 

France  has  never  been  invaded  by  the  water  quack,  but 
hydrotherapeutic  estabhshments  have  always  been  under 
the  supervision  of  quahfied  physicians.  Only  in  this  way 
is  it  possible  for  the  best  results  to  be  obtained,  for,  as  will 
be  shown,  water  is  far  too  powerful  a  therapeutic  agent 
to  be  wielded  by  any  one  who  is  unfamiliar  with  physiology 
and  has  not  undergone  the  prolonged  and  arduous  train- 
ing of  the  modern  physician. 


10 

CHAPTER    II. 
HYDROTHERAPY. 

GENERAL     PRINCIPLES. 

npHERMOTHERAPY  consists  in  the  application  of  heat 
-L  as  a  therapeutic  agent,  at  all  temperatures  and 
irrespective  of  the  media  by  means  of  which  the  heat  is  con- 
veyed. Thermal  applications  include  hot-  and  cold-water 
baths,  and  air,  vapour,  electric  light,  and  sunlight  baths. 

One  of  the  commonest  means  employed   for  conveying 
thermic  stimuli  to  the  body  is  water,  and  in  describing  the 
temperature  of  such  applications  or  procedures   {see  also 
Chart,  Fig.  43),  the  following  standard  is  customary  : — 
Very  hot  applications         temperatures         over  40°  C. 


Hot  applic 

ations 

1,7°  to  40°  C 

Warm 

,, 

of  34°  to  37°  C 

Tepid 
Cool 

" 

of  27°  to  33-5°  C 
of  18°  to  27°  C 

Cold 

5J                                            •    ■ 

of  12-5°  to  18°  C 

Very  cold 

5J 

of  0°  to   12-5°  C 

Hydrotherapy  consists  in  the  systematic  application  of 
water  at  various  temperatures  and  in  varying  form  to 
the  surface  of  the  body  for  therapeutic  purposes.  Water 
may  produce  its  effects  by  (i)  its  temperature,  (2)  its 
volume,  (3)  mechanically,  (4)  chemically. 

Water  possesses  such  physical  properties  as  render  it 
an  excellent  medium  for  conveying  temperature  impressions. 
It  has  a  remarkable  capacity  for  heat  absorption  without 
material  rise  in  temperature,  and  gives  off  heat  without 
much  temperature  reduction.  It  takes  a  much  larger  amount 
of  heat  to  raise  the  temperature  of  a  pound  weight  of  water 
1°  C.  than  an  equal  bulk  of  oil  or  metal.  It  is  for  this 
reason  that  water  is  used  for  "thermophores"  and  the 
domestic  hot-water  bottle,  and  on  this  fact  depends  the  even 
temperature  of  insular  climates.  The  heat-conducting 
power  of  water,  as  compared  with  that  of  air,  is  as  27  to  i, 
and  much  more  powerful  thermal  impressions  are  made  on 
the  skin  by  water  than  air,  the  temperature  being  the  same. 


HYDROTHERAPY  U 

As  a  result  of  different  temperatures  water  undergoes 
peculiar  changes,  solidifying  at  o°  C.  and  becoming  gaseous 
at  100°  C,  the  volume  increasing  1700  times.  The  heat 
absorbed  and  evolved  respectively  in  these  changes  in  its 
molecular  constitution  is  utilized  in  various  ways  in 
hydrotherapy. 

The  temperature  of  water,  more  than  that  of  any  other 
medium,  is  readily  adapted  to  individual  cases,  and  with 
great  precision.  The  range  of  safety  in  temperature  is 
from  1°  C.  to  48-5°  C.  ;  long-continued  application  of 
water  above  or  below  this  temperature  may  produce  tissue 
necrosis.  Water  is  thus  said  to  possess  a  high  degree  of 
thermic  flexihility  (Baruch). 

The  fluidity  of  water  allows  of  its  local  and  general  effects 
being  regulated  with  the  utmost  nicety  and  precision,  and 
the  size,  form,  and  character  of  its  application — in  the 
form  of  a  steam  or  douche — can  be  instantly  changed. 
Therapeutic  effects  of  great  value  are  brought  about  by 
the  mechanical  action  of  water  emitted  under  various 
degrees  of  pressure,  varying  from  the  mildest  stimulation 
to  intense  irritation.  Cold  and  heat,  and  all  gradations  of 
temperature,  act  as  nerve  stimuli.  The  result  of  bringing 
water,  higher  or  lower  in  temperature,  into  contact  with 
the  body  is  a  modification  of  the  quality  of  innervation 
at  the  part  of  contact.  The  sensory  peripheral  nerve 
terminations  are  brought  into  a  state  of  increased, 
diminished,  or  altered  excitability. 

The  result  depends  on  the  degree  of  difference  in 
temperature  between  the  skin  and  the  water  or  medium 
employed,  on  the  suddenness  of  application,  the  duration 
of  its  action,  the  extent  of  body  exposed,  the  variable 
sensibility  of  the  subject  treated,  and  the  simultaneous 
mechanical  and  chemical  stimulation.  The  effects  induced 
are  due  to  various  continuations  of  these  factors,  and  may 
be  purely  local  or  reflex.  Secondary  effects  also  result  from 
the  supply  or  abstraction  of  heat.  Powerful  therapeutic 
actions  may  be  brought  about  by  the  excitation  of  peripheral 
stimuli,  or  by  their  inhibition.  Digestion  and  metabolism 
may  by  this  means  be  strongly  stimulated  or  depressed ;  the 
vigour  and  frequenc}'  of  the  cardiac  systole  may  be  likewise 
influenced,  and  the  general  distribution  of  the  blood  and 


12  NATURAL    THERAPY 

local  and  general  nutrition  affected.  Widely  different 
disorders  of  metabolism — various  secretions  and  excre- 
tions— undergo  alteration. 

Local  Cooling  and  Heating. — The  effects  of  the  local 
application  of  cold  and  heat  are  as  follows  : — 

1.  Cooling  or  heating  of  the  surface  in  contact  with  the 
medium  until  the  temperature  is  almost  identical.  The 
surface  temperature  is  always  slightly  higher  or  lower  so 
long  as  the  application  of  cold  or  heat  respectively  be  not 
excessive  and  harmful. 

2.  Local  cooling  or  heating  do  not  modify  the  body 
temperature  unless  the  area  exposed  comprises  a  quarter 
of  the  body  surface. 

3.  Any  region  of  the  body  can  be  warmed  or  cooled  to 
any  desired  temperature  by  the  supply  or  withdrawal  of 
heat  for  a  sufficient  period  of  time  and  intensity  of  degree. 

4.  Heating  and  cooling  take  place  more  rapidly  the 
higher  and  the  lower  the  surrounding  temperature  after 
the  thermic  application. 

5.  The  promptitude  and  degree  of  reaction  succeeding 
heat  abstraction  and  heat  supply  are  directly  proportional 
to  the  intensity,  and  inversely  proportional  to  the  duration, 
of  the  application. 

6.  Active  and  passive  movements  of  the  part  under 
treatment  bring  about  more  rapid  restoration  of  heat  or 
cold  than  occurs  when  it  remains  at  rest. 

7.  Local  warming  is  followed  by  cooling  of  the  surface, 
and  local  cooling  by  warming,  showing  the  alteration 
of  heat  distribution. 

8.  Metabolism  is  retarded  in  cooled  and  accelerated  in 
warmed  tissues. 

General  Heating  and  Cooling. — There  are  several 
automatic  protective  agencies  against  the  general  reduction 
of  body  temperature.     Chief  among  these  are  : — 

1.  Reduction  of  the  temperature  of  the  surface  of  the 
body,  diminishing  the  heat  tension  between  skin  and  cooling 
medium  employed,  and  so  diminishing  heat  loss. 

2.  Diminution  of  circulation  in  the  skin,  and  resulting  col- 
lateral hypersemia  in  muscular  layer  of  the  entire  body.  So, 
though  the  skin  be  cooled,  the  muscular  tissue,  supplied  freely 
with  blood,  prevents  too  extensive  chilling  of  internal  organs. 


HYDROTHERAPY  13 

3.  The  rise  in  temperature  of  muscles  on  the  withdrawal 
of  heat  is  induced  not  only  by  collateral  hyperaemia  but 
also  by  reflex  thermal  influences.  While  cold  causes 
contraction  of  the  cutaneous  vessels,  it  induces  dilatation 
of  the  vessels  of  the  muscular  layer. 

4.  The  hyperaemia  of  the  muscles  tends  to  increased 
thermogenesis  in  the  tissues. 

It  will  thus  be  seen  that  the  muscular  layer  of  the 
body,  by  both  storing  and  generating  heat,  is  a  most 
powerful  agent  in  protecting  the  internal  organs  from 
excessive  cold,  and  is  in  turn  protected  by  the  skin 
covering  it. 

Physiological  Reaction  after  Hydrotherapeutic  Pro- 
cedures.— The  intensity  of  the  reaction  occurring  after 
any  bath  or  thermal  application,  while  partially  dependent 
on  the  character  of  the  procedure,  varies  greatly  with 
the  individual.  To  produce  a  proper  degree  of  reaction 
after  all  forms  of  treatment  is  most  important,  and 
depends  on  the  suitable  adjustment  of  the  stimulation 
to  the  individual,  for  the  rapidity  with  which  heat  is 
restored  after  heat  abstraction  varies  immensely  in  different 
cases.  It  is  especially  important  in  treating  any  case 
that  the  elevation  of  temperature  of  reaction  following 
heat  abstraction  be  carefully  controlled.  It  is  often 
requisite  to  diminish  or  increase  its  rapidity  or  degree. 
The  proper  restoration  of  heat  depends  on  : 

1.  The  degree  of  heat  abstraction,  ceteris  paribus  ;  the 
greater  the  abstraction,  the  more  extensive  the  rise  of 
temperature  in  reaction. 

2.  The  time  taken  in  the  process  of  heat  abstraction. 
Gradual  heat  loss  leads  to  a  gradual  reactive  process. 

3.  The  body  temperature  prior  to  the  heat  abstraction. 
If  previous  heating  be  applied,  a  better  and  quicker  reaction 
is  obtained. 

4.  The  application  of  friction  and  other  forms  of  mechani- 
cal stimulation,  hastening  the  reaction. 

5.  Exercise  subsequent  to  heat  abstraction,  quickening 
the  outset  of  reaction,  as  does  also  the  internal  adminis- 
tration of  stimulants  such  as  alcohol  and  hot  coffee. 

6.  The  heat  abstraction  not  being  carried  to  excess,  for  in 
that  case  the  reaction  may  be  much  delayed  or  incomplete. 


14  NATURAL     THERAPY 

Baruch^s  Test  for  Reactive  Capacity. — The  response  of 
the  cutaneous  circulation  to  mechanical  stimuli  is  an  index 
to  the  probable  reactive  capacity  of  the  patient.  "  Passing 
the  back  of  the  nail  of  the  index  finger  rapidly  but  gently 
across  the  surface  of  the  abdomen,  and  increasing  the 
pressure  of  the  nail  with  a  parallel  second  stroke  induces 
more  or  less  reddening  of  the  irritated  skin.  The  rapidity 
with  which  the  red  line  develops  after  the  nail  is  removed, 
and  the  pressure  required  to  produce  it,  give  a  fairly  correct 
test,  to  the  trained  observer,  of  the  patient's  reactive 
capacity." 

If  good  effects  are  to  follow  the  application  of  hydro- 
therapeutic  processes,  a  perfect  and  complete  reaction  is 
essential.  We  may  desire  to  modify  its  character  in  various 
ways,  to  induce  a  slow  or  quick  reaction,  but  an  incomplete 
reaction  is  never  beneficial  or  desirable.  It  is  characterized 
by  lassitude,  pallor,  poor  pulse,  a  chilly  feeling,  "  cold 
water  down  the  back,"  shivering,  etc.  If  repeatedly 
occurring,  it  will  seriously  disturb  the  patient's  health. 

The  beneficial  effects  of  the  hydrotherapeutic  procedures 
only  resulting  when  a  good  reaction  is  obtained,  thus 
intensifying  the  natural  defensive  powers  of  the  organism,  it 
follows  that  in  enfeebled  individuals  it  is  necessary  to 
take  all  precautions  to  bring  about  a  complete  reaction,  and 
so  ensure  the  maximum  amount  of  good  from  physical 
remedial  measures. 

The  automatic  protective  measures  against  heat  are  : — 

1.  Dilatation  of  the  cutaneous  vessels  and  acceleration 
of  the  circulation  through  the  skin  and  subcutaneous 
tissues.  By  the  application  of  heat  to  the  skin  the 
cutaneous  vessels  are  dilated,  the  circulation  is  accelerated, 
the  secretion  of  the  skin  is  increased,  and  sweat  is 
evaporated  from  the  surface.  Heat  loss  is  thus  effected, 
and  the  blood  circulating  in  the  skin  cooled.  It  returns 
to  the  internal  organs,  and  thus  prevents  their  becoming 
overheated. 

2.  If  heat  application  be  prolonged,  a  large  amount  of 
blood  will  be  retained  in  the  skin  in  consequence  of  the  loss 
of  tone  in  the  skin  vessels  ;  the  cutaneous  circulation  is 
slower,  and  the  overheated  blood  prevented  from  returning 
to  the  internal  organs,  to  their  hurt. 


HYDROTHERAPY  15 

3.  The  blood  being  diverted  to  the  skin,  a  diminished 
amount  of  blood  will  remain  in  the  internal  organs,  and 
their  activity  be  accordingly  renewed.  Excessively  rapid 
penetration  of  heat  to  internal  organs  is  thus  prevented, 
and  unduly  rapid  elevation  of  body  temperature  checked. 

Heat  Regulation,  or  Thermotaxis. — As  a  result  of  the 
stimulating  effects  of  cold,  there  first  occurs  contraction 
of  the  skin  and  its  vessels,  which  by  restricting  heat  loss 
leads  to  perfect  compensation  if  the  abstraction  of  heat 
be  slight,  partial  compensation  if  heat  loss  be  marked.  In 
the  latter  case  the  body  temperature  will  continue  to  decline 
in  greater  or  less  degree  ;  in  the  former  it  will  remain 
constant.  Alterations  in  thermogenesis  depend  on  tonic 
and  clonic  muscular  contractions  (i.e.,  muscular  tension  or 
tremulous  movements)  that  occur  involuntarily  (i.e., 
shivering)  as  the  result  of  severe  cold,  just  as  they  do  in 
consequence  of  other  sense  irritations.  These  are  less 
important  as  a  thermotactic  measure  than  the  contraction 
of  skin,  for  they  cannot  prevent  reduction  of  body 
temperature. 

Physiological  Effect  of  Heat. — Primarily,  heat  acts  as  a 
stimulant  or  excitant.  The  activity  of  cellular  protoplasm 
is  increased,  whether  the  cells  be  leucocytes,  lymphocytes, 
or  nerve  or  muscle  cells.  Such  increased  activity  is  but 
temporary,  however,  and  secondary  depression  follows  as 
the  inevitable  reaction.  This  reaction  is  due  to  increased 
heat  production  and  lower  bloodrpressure.  When  cold 
is  applied  to  the  body — in  moderate  degree — heat  produc- 
tion is  increased,  cardiac  contractions  are  stronger,  and 
blood-pressure  is  raised.  Heat  is  therefore  primarily  an 
excitant  and  secondarily  a  depressant,  while  cold  is  the 
reverse. 

The  effect  following  the  application  of  heat  depends  on 
the  form,  duration,  and  temperature  of  the  application, 
but  also  largely  on  the  condition  of  the  patient.  High 
temperatures  are  first  excitant  and  then  depressant, 
the  degree  of  depression  being  in  proportion  to  the 
length  of  the  application.  After  a  brief  one  the  depressing 
effect  may  be  insigniiicant.  Applications  of  moderate 
temperature  are  followed  by  a  less  degree  of  excitement 
and  depression. 


16  NATURAL     THERAPY 

The  abstraction  of  heat  causes  increase  in  metabolic 
activity  only  if  voluntary  or  involuntary  muscular  contrac- 
tions occur  at  the  same  time.  So  long,  therefore,  as  the 
temperature  in  the  muscle  layer  is  increased,  and  remains 
increased  in  spite  of  heat  loss,  the  stimulation  induced 
thereby  will  lead  to  increase  of  heat  production,  and  this 
constitutes  an  important  factor  in  heat  regulation. 
Further,  exercise  so  strengthens  the  heat-regulating  powers 
of  the  body  that  they  are  rendered  capable  of  compensating 
most  completely  the  supply  and  loss  of  heat. 

The  functions  of  the  skin  control  heat  loss,  voluntary 
or  involuntary ;  muscular  contraction  and  change,  in  turn, 
control  thermogenesis.  And  each  of  these  can  be  increased 
or  lessened  at  will  by  thermic  or  mechanical  influences. 


GENERAL    EFFECT    OF 
HYDROTHERAPEUTIC    APPLICATIONS. 

General  Effect  on  Metabolism. — The  general  application 
of  heat,  after  raising  the  body  temperature,  causes  increased 
oxidation  and  excretion  of  CO,.  The  blood  is  rendered 
more  resistant  to  morbid  influences  by  the  increase  of 
alexins,  and  on  this  basis  rests  the  belief  that  the  elevation 
of  temperature  in  the  exanthemata  and  various  inflamma- 
tory disorders  is  merely  a  protective  measure,  and  is,  indeed, 
remedial.  The  application  of  a  fomentation  or  poultice 
to  any  inflamed  region  hastens  repair  by  inducing  increased 
flow  of  blood  and  causing  a  local  leucocytosis.  Cold 
increases  oxidation  and  elimination  of  CO^,  and,  the 
body  temperature  remaining  constant,  heat  produces  a 
reverse  effect.  The  greater  the  thermic  nerve  stimulus, 
the  greater  will  be  the  reflex  increase  in  metabolism. 

Systematic  abstraction  of  heat  causes  secondarily  an 
increase  in  body  temperature,  leading  to  the  modification 
of  the  metabolic  processes  such  as  occurs  in  all  febrile 
conditions.  The  reduction  of  the  body  temperature  of 
a  normal  person  by  cold  application  will  lead  to  a  reactive 
process  which  tends  to  take  the  temperature  back  to  the 
normal,  or  even  above  it.  Repetition  of  such  application 
produces  in  normal  healthy  people  an  increased  reactive 


HYDROTHERAPY  17 

capacity,   and  a  tendency   to   rise   rapidly  to  the  normal 
temperature. 

Action  on  the  Skin. — Contraction  of  the  smooth  muscle 
fibres  of  the  skin  is  caused  by  brief  application  of  intense 
heat,  and  "  goose  flesh  "  results.  By  prolonged  application 
the  sweat-glands  are  excited,  and  the  amount  of  perspiration 
may  be  increased  twenty-fold.  Marked  hyperaesthesia 
is  caused  by  temperatures  of  over  50°  C.  Primary  pallor 
of  the  skin  quickly  changes  to  redness  as  the  cutaneous 
vessels  dilate,  and  with  the  reaction  later  pallor  returns. 

Action  on  the  Muscles  and  Muscular  Tissue. — Increase 
and  diminution  in  tension  of  all  muscle  tissues  are  induced 
by  the  application  of  thermic  or  mechanical  stimuli,  both 
voluntary  and  involuntary  muscles  being  affected.  The 
application  of  cold,  and  of  massage  or  friction,  increases 
the  tone  in  all  voluntary  muscle  tissue.  The  muscular 
tissue  ma}/  simply  be  increased,  or  clonic  or  toxic  spasm 
induced.  There  is  increased  production  of  heat,  and  of 
capacity  for  withstanding  fatigue.  Temporary  application 
of  heat  will  produce  similar  effects,  but  if  prolonged  this 
leads  to  fatigue  and  weakness,  and  lessens  heat  production. 

Muscular  energy  is  increased  by  brief  hot  appliances  ; 
relaxation  results  from  longer  applications.  Practically 
we  utilize  this  latter  action  in  relieving  cramp  of  a  muscle, 
or  of  the  stomach  or  intestine. 

Action  on  the  Nervous  System. — Reflex  excitement  of 
the  nerve  centres  is  induced  by  brief  applications  of  heat  ; 
exhaustion  follows  if  they  are  prolonged.  By  warm  or 
hot  applications  nerve  sensibility  is  subdued,  and  a 
comfortable  sensation  induced,  without  depression  or 
lassitude. 

Effect  on  Blood  Constitution. — The  application  of  cold 
to  the  body  surface  usually  induces  a  varying  degree  of 
leucocytosis  and  increase  of  erythrocytes,  while  the  colour 
index  also  rises.  The  leucocytosis  may  amount  to  18,000  or 
20,000 ;  the  erythrocytes  may  increase  by  i  or  1}  millions, 
and  the  haemoglobin  often  by  12  or  15  per  cent.  These 
effects  are  usually  obtained  within  an  hour.  The  increase 
is  only  temporary,  however,  being  comparable  to  the 
physiological  increase  in  haemoglobin  occurring  after  an 
ordinary    meal.     Active    muscular    exercise    has    a    very 

2 


18 


NATURAL     THERAPY 


similar  effect.  If  a  good  reaction  be  not  obtained  these 
effects  are  not  produced,  but  on  the  contrary  there  may  be 
a  diminution  in  the  number  both  of  erythrocytes  and 
leucocytes. 

Warm  fomentations  and  poultices  cause  a  local  increase 
in  the  leucocytes,  and  a  diminution  in  red  cells,  while  warm 
sitz  baths  cause  a  general  reduction  in  both  types  of  cells 
as  well  as  in  haemoglobin  percentage. 

Winternitz  considers  there  is  a  fallacy  in  this  increased 
blood-count  above  spoken  of.  He  points  out  the  marked 
difference  in  composition  of  blood — as  regards  percentage 
of  cellular  elements — in  a  drop  taken  from  the  finger  tip  and 
one  taken  from  the  abdominal  wall.  He  further  attributes 
the  temporary  leucocytosis,  etc.,  to  brisker  circulatory 
conditions  sweeping  out  into  the  general  blood-stream 
leucocytes  and  red  cells  which  w^ere  stagnating  in  various 
internal  organs.  He  points  out  that  though  the  increase 
is  only  temporary  in  large  degree,  still  gaseous  interchange 
is  encouraged  here,  oxygen  being  taken  up  and  CO^  thrown 
out  in  the  respiration,  and  nutritive  processes  being 
heightened ;  while  by  methodical  repetition  of  the  thermic 
applications  which  lead  to  the  temporary  effect,  a  permanent 
one  is  attained. 

Action  on  the  Cardio-Vascular  System  — Application  of 
cold  at  first  quickens  the  cardiac  beats,  and  later  slows  but 


AKKKKM 


Fig.  2. — Effect  of  Cold  Application  on  the  Pulse  Tracing:    (a)  Before;    (h)  After. 

strengthens    them,    whilst    hot    applications    produce    the 
reverse  effects.     There  is  a  lengthening  of  the  diastole,  with 


HYDROTHERAPY 


19 


improved  cardiac  nutrition.  Similarly,  as  regards  the 
peripheral  circulation,  there  is  a  primary  vasoconstriction 
and  then  vasodilatation.  The  blood-pressure  itself  rises 
after  the  application  of  cold  as  much  as  30  mm.  of  Hg  in 
many  cases,  and  is  lowered  to  a  somewhat  similar  extent 
after  application  of  heat.  In  both  cases  dilatation  of 
the  vessels  occurs,  but  cold  is  a  vasomotor  stimulant. 
While  very  hot  applications  produce  a  degree  of  cardiac 
excitement,  the  major  effect  is  vascular  dilatation  and 
lowered  blood-pressure. 


Fig.  3. — Effect  of  Hot  Application  on  the  Pulse  Tracing  :   (a)  Before     (b)  After. 

Primary  contraction  and  secondary  relaxation  of  the 
blood-vessels  are  produced  by  heat,  this  passive  dilatation 
causing  reddening  of  the  skin  through  cutaneous  vessels. 
The  effects  of  local  applications  of  hot  compresses,  hot 
baths,  etc.,  depend  on  the  fact  that,  while  the  peripheral 
vessels  of  any  area  are  in  a  dilated,  hyperaemic  condition, 
those  of  the  central  or  remaining  portion  are  contracted, 
a  compensatory  anaemia  of  the  region,  be  it  internal 
organ  or  joint,  resulting. 

When  we  consider  that  the  cutaneous  vessels  are 
capable  of  containing  two-thirds  of  the  total  amount 
of  blood,  we  are  able  to  see  how  powerful  an  influence  is 
exerted  on  blood-pressure  and  internal  congestion  by  the 
dilatation  of  the  whole  or  an}^  part  of  the  cutaneous 
"  heart."  The  red  blood  cells  are  diminished  by  the  general 
or  local  application  of  heat,  while  a  leucocytosis  is  induced. 
The  alkalinity  of  the  blood  is  lowered  also.    The  volume 


20  NATURAL     THERAPY 

of  the  blood  is  lessened  by  the  prolonged  application  of 
heat,  owing  to  loss  of  fluid  by  the  profuse  perspiration 
thereby  induced. 

Action  on  Respiration. — Dry  heat  hinders  the  respiratory 
gaseous  exchange,  quickening  the  rate  of  respiration,  but 
rendering  it  less  efficient  and  deep.  The  rate  of  respiration 
is  increased  by  a  general  hot  bath,  and  after  a  little  the 
respirations  are  deeper  in  character.  The  skin  is  rendered 
active,  with  resultant  diaphoresis,  but  in  addition,  much 
moisture  and  toxic  material  is  thrown  off  by  way  of  the 
lungs. 

The  body  temperature  is  raised  by  a  bath  over  37°  C,  owing 
to  interference  with  heat  elimination.  The  amount  of 
the  rise  will  depend  on  the  temperature  and  duration  of 
the  bath  and  the  body-weight  of  the  patient.  A  bath  at 
■^y°  C.  for  half  an  hour,  the  patient  being  an  average  size 
male  adult,  will  cause  a  rise  of  only  2°  C.  to  3°  C,  while  if 
the  temperature  be  38°  C.  the  rise  may  be  as  much  as  1-5° 
or  3°  C.  The  dilatation  of  the  skin  vessels  induced  by 
a  brief  hot  bath  will  often  cause  a  fall  of  temperature, 
owing  to  increased  heat  loss. 

Action  on  the  Internal  Organs. — It  is  a  notorious  fact 
that  the  application  of  a  cold  bath  in  an  abdominal 
examination  induces  rigidity  of  the  abdominal  wall,  owing 
to  increased  tone  of  the  muscles  ;  whilst  the  relaxing 
effect  of  heat  is  frequently  made  use  of  in  the  reducing 
of  herniae,  and  the  relief  of  spasms,  colics,  etc.  If  however, 
cold  be  applied  to  the  abdominal  muscles,  not  only  are 
they  themselves  contracted,  but  the  involuntary  muscular 
tissue  of  the  stomach,  intestine,  gall-bladder,  etc.,  also 
contracts.  Relaxed  abdominal  muscles  lead  to  diminished 
intra-abdominal  tension,  portal  engorgement,  and  conges- 
tion of  the  viscera.  Gastric  dilatation,  indigestion,  and 
constipation  may  result,  with  consequent  malaise  and 
malnutrition. 

Blood  may  be  diverted  from  any  inflamed  or  congested 
viscus  by  the  application  of  intense  moist  and  dry  heat 
to  the  skin  surface,  and  the  circulation  through  any  of  the 
viscera  may  be  variously  influenced  by  the  alternate  appli- 
cation of  heat  and  cold.  In  this  way  morbid  processes  may 
be  powerfully  influenced  and  functional  activity  increased. 


HYDROTHERAPY  21 

The  drinking  of  very  hot  water,  in  sips,  excites  both  the 
motor  and  secretory  activity  of  the  gastric  wall  and 
stimulates  the  circulation. 

Very  hot  and  cold  applications  to  the  epigastrium  also 
increase  both  secretion  and  peristaltic  activity.  Warm 
applications  have  the  reverse  effect. 

By  hot  applications  to  the  right  hypochondrium  increased 
secretion  of  bile  is  induced,  and  the  hepatic  circulation 
generally  stimulated.  This  action  is  increased  if  a  hot 
fomentation  be  followed  by  a  "  heating  "  compress.  Distinct 
contraction  of  the  spleen  is  effected  by  similar  treatment. 

A  general  hot  application,  sufficient  to  induce  free 
perspiration,  greatly  relieves  acute  or  subacute  inflammation 
of  the  kidneys  ;  a  hot  bath,  short  of  perspiration,  increases 
renal  activity  and  promotes  free  flow  of  urine. 

General  Indications. — The  stimulating  effects  of  heat 
are  utilized  in  dealing  with  conditions  of  extreme  exhaustion 
from  over-exertion  or  toxaemia.  The  diaphoretic  effect 
of  heat  is  of  immense  value  in  the  treatment  of  many 
conditions,  e.g.,  acute  and  chronic  rheumatism,  severe 
chill,  uric  acid  diathesis,  diabetes,  parasyphilides,  bronchial 
catarrh,  chronic  inflammations  of  the  gastro-intestinal 
tract,  kidneys,  or  pelvic  viscera. 

Deep-seated  inflammations  are  treated  by  means  of 
local  applications  to  the  appropriate  cutaneous  surface 
or  by  general  applications.  In  pelvic  inflammation,  e.g., 
pain  is  greatly  relieved  by  a  hot  hip  pack,  a  general  blanket 
pack,  or  hot  full  bath. 

Toleration  of  Exposure  to  Heat. — The  degree  of  heat 
which  can  be  safely  borne  by  a  human  being  is  dependent 
on  the  rarity  or  density  of  the  medium  supplying  the  heat, 
and  its  capacity  for  absorbing  moisture.  When  a  medium 
is  very  absorbent,  perspiration  is  encouraged,  and  scalding 
avoided,  even  when  a  very  high  temperature  is  employed. 
A  full  bath  at  a  temperature  of  45°  C.  is  tolerable  for  eight 
minutes  by  the  average  European  (the  Japanese  can  take 
considerably  hotter  baths  with  comfort  and  safety). 
General  hot-air  baths  of  127°  C.  can  be  borne  for  the  same 
time,  and  local  hot-air  applications  at  considerably  higher 
temperatures.  Sweating  is  easy  in  a  hot-air  bath,  more 
difficult  in  vapour  baths,  and  most  of  all  in  hot-water  baths. 


22 


NATURAL    THERAPY 


Pelvic  Organs  j' 
Intestines,  lirain  v 


Fig.  4.— Anterior   Cutaneous   Areas   rtflexly   associated    willi    Internal    Parts. 


HYDROTHERAPY 


23 


Brain 


Genito-urinary 

Organs 
I5o\vels  &  Brain 


^'§-  5- — Posterior   Cutaneous  Areas   reflexly   associated  with    Internal  Parts. 


24  NATURAL    THERAPY 

The    Basis    of  Hydrotherapeutic  Applications. — For  an 

intelligent  understanding  of  the  therapeutic  effects  of  hot  and 
cold  applications,  one  must  consider  the  anatomical  facts. 
The  effects  resulting  from  applications  of  heat  and  cold  to 
the  body  surface  depend  on — 

1.  The  general  body  temperature  and  the  temperature 

induced  locally  by  the  application  ; 

2.  The   remote    changes    reflexly   produced    by   nervous 

influence  ; 

3.  The  local  vascular  connections. 

Nerve  reflexes. — As  regards  nervous  influence,  there  are 
definite  cutaneous  reflex  areas  for  each  viscus  from  which 
the  most  intense  reflex  impressions  are  received. 

The  theor}'  of  counter-irritation  is  dependent  on  the 
correlation  of  the  afferent  visceral  and  somatic  nerves,  to 
which  is  also  due  the  well-known  phenomenon  of  "  referred 
pain."  The  existence  of  definite  cutaneous  reflex  areas  for 
each  viscus  has  been  above  referred  to.  If,  from  disease,  a 
centripetal  impression  originates  in  any  viscus,  this  induces 
a  further  stimulation  in  the  nerve  fibres  coming  from  the 
corresponding  segmental  skin  area,  and  gives  rise  to 
"  referred  pain." 

The  afferent  visceral  and  cutaneous  nerve  fibres  come 
into  close  relation  in  the  ganglion  of  the  posterior  root,  and 
the  reflex  impulse  starts  here  or  in  the  grey  matter  of  the 
cord. 

Conversely,  any  form  of  counter-irritation  on  the  appro- 
priate skin  area  in  visceral  disease  usually  acts  beneficially. 

Vascular  areas. — It  has  already  been  demonstrated  that 
there  is  an  intimate  and  direct  relation  between  the  visceral 
blood-vessels  and  the  superincumbent  cutaneous  vessels. 
There  are  particularly  free  and  ample  connections  with 
the  skin  surface  as  regards  the  brain,  middle  ear,  nose,  and 
orbit.  The  vessels  of  the  lungs  are  related  collaterally 
with  the  skin  over  the  arms,  chest,  and  upper  portion 
of  the  back.  The  pericardium  and  parietal  pleura  of  the 
interior  portion  of  the  chest  are  related  with  the  overlying 
skin  through  the  intercostal  arteries.  The  posterior  parietal 
and  visceral  pleura  are  collaterally  related  with  the  inter- 
costal vessels.  In  addition  there  are  free  connections 
through   the   inferior  thyroid   and   the   bronchial   arteries, 


HYDROTHERAPY 


25 


Error  of  eyt-refracli 
Gutric  dr^p^pnia 


Dccajod  teetb. 


Fig.  6. — Cut:ineous  Areas  associated  reflexly  with  Visceral  Pain  (Dana), 


26  NATURAL    THERAPY 

the  azygos,  bronchial,  and  intercostal  veins.  The  kidneys 
are  associated  with  the  skin  covering  the  loins  through 
the  renal  branches  of  the  lumbar  arteries.  There  is  a 
collateral  venous  and  arterial  relationship  between  the 
stomach,  liver,  spleen,  intestines,  and  pancreas.  The 
intimate  relationship  between  the  portal  and  general 
circulation  is  well  known. 

In  similar  manner  the  upper  portions  of  the  body  are 
related  to  the  lower.  The  regions  below  the  umbilicus 
are  collaterally  related  with  the  head,  arms,  and  upper 
half  of  the  trunk  ;  the  legs  have  a  close  collateral  connection 
with  the  pelvic  viscera. 

With  these  facts  before  us,  it  is  easy,  therefore,  to  under- 
stand how  the  volume  of  blood  in  any  viscus,  it  matters 
not  how  remote  from  the  surface,  may  be  diminished, 
either  by  a  general  hot  application  to  the  skin,  or  by  a  local 
application  to  a  less  extent.  In  this  manner  is  to  some 
extent  explained  the  good  effect  of  a  hot  foot  bath  or  sitz 
bath  on  an  arterial  congestion  or  common  cold,  the  relief 
afforded  to  infantile  croup  by  a  hot  sponge  on  the  larynx, 
and  the  comfort  afforded  by  a  fomentation  to  an  aching 
stomach  or  an  icebag  to  a  dry  pleurisy. 

The  facts  above  considered  constitute  the  scientific  basis 
for  many  thermal  and  hydrotherapeutic  applications, 
and  for  the  whole  practice  of  counter-irritation.  For 
our  knowledge  of  the  various  communications  between 
the  skin  areas  and  the  viscera  dealt  with  above,  we  are 
indebted  chiefly  to  the  work  of  Winternitz,  Rosbach, 
Foster,  and  Head. 


THE     INTERNAL 
ADMINISTRATION     OF    WATER. 

I.  By  the  Mouth. — Water,  when  introduced  into  the 
stomach,  is  taken  up  by  the  tissues  of  the  body  with  greater 
or  less  rapidity,  and  remains  in  contact  witli  tlie  tissues  for 
a  considerable  period  of  time.  It  comes  into  immediate 
contact  with  the  various  portions  of  the  digestive  canal. 
It  has  a  special  influence  on  the  most  intimate  nutritive 
processes  by  reason  of  its  chemical   constitution   and   the 


HYDROTHERAPY  27 

equalization  of  its  temperature  with  that  of  the  body.  It 
further  renders  the  tissues  throughout  the  body  permeable 
by  all  water-soluble  substances  taken  in  the  form  of  food. 

The  effect  of  drinking  a  quart  of  cold  (18°  C.)  water 
rapidly,  is  to  diminish  the  fulse  frequency  by  22  beats  in 
30  seconds  ;  in  ten  to  twelve  minutes  it  becomes  normal 
again.  If  the  water  temperature  be  lower  the  pulse 
declines  rather  more  rapidly. 

The  temperature  of  the  body  declines  with  the  pulse  beats 
to  the  extent  of  about  -5°  C,  but  in  about  ten  minutes 
returns  to  the  previous  level. 

By  drinking  cold  water  the  temperature  of  the  stomach 
is  lowered  considerably — to  the  extent  of  at  least  -5°  C. — 
and  the  original  temperature  is  not  regained  for  several 
hours.  If  the  rectal  temperature  be  taken,  it  will  be  found 
that  a  lowering  of  over  1°  C.  takes  place  rapidly,  and  this 
lower  temperature  is  continued  for  upwards  of  an  hour. 
An  intimate  reaction  evidently  exists  between  stomach  and 
rectum,  for  if  a  person  be  given  a  large  cold-water  enema, 
the  temperature  of  the  stomach  declines  nearly  1°  C. 
(Winternitz.) 

It  is  thus  evident  that  the  body  temperature  can  be 
influenced  by  the  imbibition  of  water,  and  further,  the 
temperature  of  various  deep-seated  organs  can  also  be 
influenced.  There  is  a  sound  basis  furnished  for  the  pre- 
scribing of  systematic  water  drinking,  and  the  marked  local 
and  general  therapeutic  effects  obtained  are  explained.  It 
must  be  borne  in  mind  that  the  vasomotor  system  also 
has  considerable  influence. 

The  rapidity  with  which  the  absorption  of  water  takes 
place  depends  on  a  variety  of  circumstances.  The  lower 
the  blood-pressure  at  the  moment  of  taking  the  water, 
the  more  rapidly  will  it  be  absorbed  into  the  blood-vessels. 
After  considerable  fluid  loss  from  the  body  owing  to  normal 
or  pathological  causes — such  as  free  diuresis,  profuse 
perspiration,  diarrhoea,  or  bleeding — rapid  absorption  of 
fluid  from  the  intestinal  tract  will  take  place. 

Pure  spring  water,  containing  little  saline  matter,  is  more 
rapidly  taken  up  by  the  blood-stream  than  water  containing 
much  saline  matter.  A  carbonaceous,  gaseous  water  is 
more  grateful  to  the  stomach,  and  more  rapidly  absorbed. 


28  NATURAL     THERAPY 

than  a  still,  alkaline  water,  which  may  cause  gastric  dis- 
comfort and  "  fullness,"  even  if  drunk  in  small  quantity. 

After  free  consumption  of  water,  the  blood  is  somewhat 
diluted  temporarily,  and  the  blood-pressure  rises.  The 
larger  the  quantity  of  water  drunk  the  greater  and  the 
more  enduring  is  the  effect  on  the  blood-pressure,  which 
does  not,  however,  continue  for  above  three  and  a  half 
minutes.  The  increase  of  the  water  in  the  blood  can  only 
be  demonstrated  for  a  very  short  time.  In  less  than  an 
hour  the  blood  has  regained  its  former  density.  In  one 
hour  water  which  has  been  imbibed  begins  to  appear  in  the 
tissues,  and,  normally,  the  entire  amount  is  eliminated  in 
three  and  a  half  hours.  Large  quantities  are  relatively 
more  rapidly  eliminated  than  small  quantities.  It  follows 
that  such  a  condition  as  hydrsemic  plethora  is  an  impossi- 
bility, even  when  excessive  quantities  of  water  are  consumed. 
Not  only  is  this  so,  but  the  drinking  of  cold  water  acts  as 
a  diuretic,  and  aids  in  the  removal  of  water  not  recently 
imbibed.  Warm  water,  while  it  will  for  a  short  time 
stimulate  the  kidneys  to  increased  action,  soon  results  in 
perspiration.  The  diuretic  action  of  water  depends  not  so 
much  on  the  quantity  actually  imbibed,  as  on  the  general 
increase  of  blood-pressure  and  freer  circulation  through  the 
kidneys  at  greater  pressure.  With  the  increased  output  of 
water  the  solid  constituents  of  the  urine  are  also  increased, 
especially  urea  and  uric  acid. 

Method  of  Prescribing. — The  method  adopted  in  pre- 
scribing water  will  obviously  vary  with  the  effect  we  wish 
to  produce. 

If  we  desire  to  flood  the  body  tissues  and  raise  the 
blood-pressure,  water  is  given  in  single  small  doses  ol 
5  or  6  ounces,  repeated  every  twenty  minutes  or  half-hour 
for  a  considerable  time. 

On  the  other  hand,  if  the  object  is  to  promote  the 
absorption  of  fluid  transudates,  a  pint  or  more  of  water 
should  be  given  every  six  to  eight  hours,  and  all  fluids 
withheld  in  the  interval.  Not  only  may  the  removal  of 
dropsy  or  other  effusion  be  thus  greatly  helped,  but  the 
absorption  of  inflammatory  exudates  is  greatly  accelerated. 

The  loss  from  the  body  is  greatly  increased  by  the  free 
drinking  of   water,    and,  food   being   restricted,  the  blood 


HYDROTHERAPY  29 

regenerates  itself  from  the  tissues,  leading  to  a  retrogressive 
metamorphosis. 

While  moderate  consumption  of  water,  with  suitable  food, 
causes  a  gain  in  body-weight,  excessive  water  drinking 
causes  loss  of  weight. 

The  processes  of  oxidation  are  stimulated  and  rendered 
more  efficient,  as  can  be  demonstrated  by  the  large 
quantities  of  CO^  eliminated  and  the  small  quantity  of  uric 
acid  and  kreatinins  formed  in  the  blood.  Metabolism 
throughout  the  whole  body  is  increased  and  accelerated. 

The  chilling  of  the  stomach  caused  by  drinking  cold 
water  {vide  supra)  evidences  the  undesirability  of  excessive 
drinking  during  meals.  Apart  from  this,  the  drinking  of 
cold  water  stimulates  the  liver,  quickens  the  flow  in  the 
portal  vein,  and  increases  the  secretion  of  bile. 

2.  By  the  Rectum. — Rectal  injections  of  water  at  various 
temperatures  are  used  for  many  purposes,  e.g.,  to  procure 
an  action  of  the  bowels,  to  restrain  diarrhoea,  to  soothe  pelvic 
pain,  to  get  rid  of  intestinal  parasites,  particularly  Oxyuris 
vermicularis,  and  to  compensate  for  fluid  loss  from  haemor- 
rhage or  otherwise.  So  far  as  relief  of  the  bowels  is  con- 
cerned it  must  be  clearly  understood  that  an  enema  seldom 
accomplishes  its  purpose  by  merely  washing  away  faecal 
matter.  As  a  matter  of  fact,  it  quite  often  scarcely  reaches 
the  faecal  matter  which  may  lie  high  up  in  the  colon.  It 
rather  effects  its  purpose  by  inducing  a  more  vigorous 
peristaltic  action. 

B}^  the  distention  with  water  of  the  lower  portion  of  the 
bowel,  a  local  vermicular  action  is  started  which  spreads 
along  the  bowel.  If  the  enema  be  too  small  in  bulk,  disten- 
tion of  the  rectum  is  not  effected. and  failure  results. 

The  amount  as  well  as  the  temperature  of  the  water 
required  varies  greatly  with  circumstances  and  individuals. 
Anything  from  half  a  pint  to  three  or  four  pints  or  more 
may  be  needed.  Warm  and  hot  enemata  are  more  stimu- 
lating and  effective  than  cold. 

If  a  large  injection  is  to  be  given,  the  patient  should  lie 
on  his  left  side,  with  knees  drawn  up,  and  fluid  be  slowly 
pumped  into  the  rectum.  After  a  varying  time  the  patient 
feels  unable  to  retain  more  and  has  a  colicky  pain  in  the 
abdomen,  and  desires  to  relieve  the  bowels  ;  this  desire  may 


30  NATURAL     THERAPY 

be  gratified,  or,  if  a  large  enema  is  deemed  necessary,  the 
patient  is  asked  to  endeavour  to  retain  the  water,  and  helped 
by  means  of  a  folded  towel  pressed  over  the  anus,  pumping 
having,  of  course,  ceased  in  the  meantime.  The  desire  to 
defaecate  will  soon  pass  off,  and  then  more  water  can  be 
introduced.  It  is  often  more  convenient  to  use  a  douche  can, 
and  allow  the  water  to  enter  by  gravity  only.  Less  straining 
is  thus  induced,  and  by  this  means  the  patient  can  carry 
out  the  procedure  unassisted. 

When  complete  irrigation  of  the  colon  is  desired,  as  many 
as  six  to  eight  pints  may  be  introduced  by  this  method ;  but 
the  frequent  use  of  large  enemata  induces,  eventually,  an 
atonic  condition  of  the  bowel,  and  the  last  state  of  the 
patient  is  worse  than  the  first. 

In  some  cases  when  constipation  is  obstinate  and  long- 
standing, as  is  common  in  mental  disease  and  diabetes,  the 
injected  water  may  come  away  quite  clear,  and  have  no 
relieving  action  on  the  bowels.  Under  such  circumstances, 
if  even  warm  enemata  do  not  accomplish  their  purpose, 
kneading  the  abdomen  along  the  course  of  the  colon 
must  be  employed  as  an  adjuvant,  and  even  actual 
removal  of  the  faeces  by  digital  efforts  or  a  spoon  may  be 
necessary. 

Where  it  is  desired  to  introduce  fluid  to  be  actually 
retained  and  absorbed  by  the  patient,  the  use  of  a  long 
rectal  tube  is  often  an  advantage. 

Warm  injections  often  materially  lessen  the  pain  of  cancer 
of  the  bowel,  and  relative  distressing  tenesmus  and  straining. 
They  are  also  of  use  in  cystitis,  prostatic  abscess,  and  para- 
metritis. Irrigation  of  the  colon  for  chronic  mucous  colitis 
is  now  very  extensively  employed,  a  special  feature  being 
made  of  it  at  Harrogate. 

In  gastric  dilatation,  etc.,  where  it  is  desired  to  give  the 
stomach  a  complete  rest  from  fluid,  the  tissues  may  be  kept 
properly  supplied  per  rectum,  with  great  ease,  and  much 
to  the  patient's  comfort  and  well-being. 

The  value  of  large  injections  of  plain  or  slightly  alkaline 
water  in  the  condition  of  mucous  colitis  has  long  been  known. 
Recently  this  has  been  done  from  above  downwards  by 
means  of  a  small  opening  formed  for  the  purpose  in  the 
colon  by  the  operation  of  appendicostomy. 


HYDROTHERAPY 


31 


IRRIGATION. 

Vaginal  Douching  or  Irrigation  (as  Kellogg  thinks  it 
should  more  properly  be  called). — This  consists  in  the 
injection  into  the  vaginal  canal  of  a  stream  of  cold,  hot,  or 
tepid^water,  under  but  slight  pressure. 

Its  value  in  various  uterine, 
ovarian,  and  other  pelvic  dis- 
orders to  which  women  are 
subject,  is  generally  recognized. 
To  obtain  the  best  results 
some  little  attention  to  the 
details  of  the  technique  is 
requisite.  A  gravity  syringe  is 
usually  employed,  the  water 
being  contained  in  a  can  or 
glass  reservoir  which  rests  on 
a  shelf  or  stool  some  three  feet 
above  the  patient,  or  special 
appliances  are  made  {Fig.  7). 
The  water  is  conducted  to  the 
vagina  by  means  of  a  rubber 
tube,  terminating  in  a  glass  or 
vulcanite  nozzle.  The  patient 
lies  on  her  back,  and  the  water 
passes  out  of  the  vagina  into  a 
suitable  receptacle  arranged  to 
catch  it.  Dr.  Kellogg  has 
devised  a  special  form  of  table 
made  of  marble.  The  table 
being  hollowed  to  fit  the 
patient's  back,  and  an  opening 
provided  to  conduct  the  water 
rapidly  away  without  wetting 
the  patient's  clothing,  asepsis 
is  specially  easy  to  maintain. 

In  introducing  the  vaginal 
tube,  care  is  needed  to  pass  it 
into  the  posterior  vaginal  fornix 
as  far  as  possible,  and  thus 
avoid  any  chance  of  injecting 


■Ft?.  7- — An  adjustable  Gravity  Syringe. 


the  water  into  the  uterine  cavity. 


32  NATURAL     THERAPY 

The  idea  is  to  allow  the  water  to  circulate  freely  around 
the  neck  of  the  uterus  and  in  the  vagina,  bringing  every 
part  under  its  influence.  The  mucous  membrane  is  directly, 
and  the  pelvic  viscera  reflexly,  affected. 

Effects. — Both  hot  and  cold  applications  are  useful  in 
relieving  haemorrhage  due  to  uterine  congestion,  chronic 
metritis,  etc.  Cold  water  is  generally  more  efficient  in 
this  respect  than  hot.  Hot  douches  lessen,  and  even 
completely  arrest,  uterine  contractility  and  excitability, 
which  cold  douching  increases.  Further,  cold  douches  may 
cause  painful  uterine  contractions  and  aggravate  neuralgic 
uterine  and  pelvic  pains,  so  that  water  of  the  higher 
temperatures  is  most  commonly  employed.  A  douche  of 
a  temperature  of  32°  C.  is  of  great  service  in  relieving  pelvic 
congestions.  Temperatures,  below  6°  C.  are  practically 
never  employed,  but  a  douche  of  25°-27°  C.  is  very  fre- 
quently of  service. 

Very  hot  irrigations  are  employed  to  check  haemorrhage, 
a  temperature  of  5o°-55°  C.  being  utilized.  Hot  irriga- 
tions of  45°-47°  C.  relieve  pain,  and  promote  the  absorption 
of  exudates  in  parametritis  and  pelvic  cellulitis  ;  they  are 
of  service  in  chronic  metritis,  ovaritis,  and  endometritis. 

For  intra-uterine  irrigation  only  distilled  or  sterilized 
water  must  be  used. 

Rectal  Irrigation. — The  rectal  irrigator  {Fig.  8),  or 
psychrophore  of  Artzberger,  is  a  faucet-like  hollow 
instrument,  permitting  the  inflow  and  outflow  of  water,  the 
temperature  of  which  will  vary  with  circumstances. 


Fig.  8. — Rectal  Irrigator. 


Before  introduction  into  the  rectum,  the  irrigator  should 
be  well  lubricated  with  vaseline  or  lanolin,  and  the  patient 
— placed  in  a  suitable  posture — asked  to  "  bear  down." 

The  temperature  of  the  water  (which  should  be  flowing 
from  an  ordinary  douche-can  at  an  elevation)  used  at  the 


HYDROTHERAPY 


33 


commencement,  should  not  be  lower  than  20°  C.  in  most 
cases  ;  and  if  there  be  any  inflammatory  condition  in  the 
region  of  the  bladder  neck,  very  disagreeable  strangury 
and  tenesmus  may  be  excited.  The  effect  of  the  application 
is  both  tonic  and  to  some  extent  soothing  and  anaesthetic. 

This  procedure  is  serviceable  in  haemorrhoids  and  various 
chronic  and  acute  inflammatory  conditions  of  the  rectum 
and  its  vicinity.  Hot,  cold,  and  hot  and  cold  water 
alternately,  are  variously  employed,  according  to  results 
desired. 

The  Urethral  Cooling  Sound  or  Psychrophore  of 
Winternitz. — This  is  an  ordinary  two-way  catheter  {Fig.  9). 
It  is  introduced  just  like  an  ordinary  catheter,  but  should 
stop  short  of  the  bladder  cavity,  just  as  the  sphincter 
vesicae  grips  the  instrument.  A  fairly  large  (No.  12-14) 
size  is  generally  used,  at  any  rate  after  the  first  time.  The 
water  temperature  at  first  should  be  20°-22°  C,  and  be 
reduced  to  10°  C.  gradually.  Prior  to  the  introduction  of 
the  sound  the  patient  should  empty  his  bladder. 


Fig.  9. — Winternitz'   Urethral   Psychrophore, 


Although  some  vesical  tenesmus  may  occur  at  first,  it 
soon  passes  off.  The  effect  of  the  procedure  is  in  the  main 
cooling  and  tonic. 

The  sound  should  remain  in  position  for  four  to  five 
minutes  at  first,  and  then  longer — up  to  thirty  minutes. 
It  is  generally  used  on  alternate  days. 

Therapeutic  Indications.  —  This  measure  is  useful 
in  testicular  neuralgia  and  in  nocturnal  enuresis.  It  is 
also  of  use  in  atonic  psychical  impotence,  in  spermator- 
rhoea, prostatorrhoea,  and  chronic  gleet,  a  very  wide  bore, 
up  to  20-24,  being  used  for  this  last  affection  (Keyes). 


34 


CHAPTER    III. 

ON    THE    TAKING    OF    BATHS. 

npHE  technique  of  hydrotherapy  has  reached  a  very 
J-  high  degree  of  development,  and  such  a  variety  of 
baths  are  employed  at  the  present  day,  and  there  are  so 
many  modifications  of  them,  that  it  is  now  possible  to 
adapt  special  hydriatric  procedures  to  each  individual  case 
coming  before  us  for  treatment. 

In  every  variety  of  bathing  procedure  the  points  of  the 
highest  importance  are,  the  temperature  of  the  water  applied, 
the  amount  of  pressure  under  which  it  is  applied,  the 
friction  produced,  and  the  duration  of  the  application. 
By  varying  these,  the  same  effects  can  be  produced  by 
very  different  methods.  Winternitz  lays  great  stress  on 
the  importance  of  the  measure  of  stimulation  in  each. 

It  is  customary  to  cool  the  head  thoroughly  before  every 
cool  or  warm  application,  and  to  keep  it  wrapped  up  in 
some  cool  covering  during  the  whole  of  the  process.  This 
helps  to  prevent  ill-effects  through  the  blood  being  driven 
inwards  by  the  cooling  of  the  skin  surface,  and  inducing 
what  Winternitz  calls  "  retrograde  hydrostatic  congestion  " 
of  any  of  the  internal  organs,  but  more  especially  the  brain. 

If  a  hot  application  be  used,  cooling  of  the  head  is  also 
desirable ;  for  here  again  internal  congestion  is  caused,  and 
in  old  and  plethoric  patients  there  is  a  tendency  to  apoplexy. 

It  is  of  course  essential  when  any  bath  is  ordered  by 
a  physician  that  a  specific  statement  be  made  as  to  the 
temperature  of  the  water  to  be  employed  and  the  duration 
of  the  application. 

GENERAL    PRECAUTIONS    AS    TO    THE    TAKING 

OF    BATHS. 

I.  A  careful  examination  of  the  cardio-vascular  system 
should  be  made  before  the  physician  prescribes  any  bath 
or  set  of  baths. 


ON     THE     TAKING     OF     BATHS  35 

2.  Extreme  temperatures  are  specially  undesirable  in 
children  and  elderly  people,  and  also  in  women  at  the  time 
of  the  climacteric.  During  the  catamenial  flow  hydriatric 
procedures  should  for  the  most  part  be  suspended. 

3.  Every  bath  has  an  effect  which  is  either  stimulant  or 
sedative  ;  which  of  these  predominates  will  depend  on 
various  circumstances,  such  as  the  range  of  temperature 
and  duration  of  the  procedure,  also  the  time  of  the  day  and 
general  condition  of  the  patient. 

4.  Care  is  very  necessary  not  to  prolong  thermal  baths 
sufficiently  to  cause  depression  or  lassitude. 

5.  Hot-air  and  vapour  baths  should  never  be  employed 
in  febrile  conditions,  unless  in  incipient  catarrhal  conditions 
and  chills. 

6.  Too  stimulating  procedures  or  a  prolonged  course  of 
treatment  are  often  followed  by  circulatory  depression  and 
considerable  debility. 

7.  In  chronic  diseases,  during  the  first  week  or  two  of 
treatment  there  is  often  some  exacerbation  of  symptoms, 
which  is  not  an  unfavourable  sign,  and  passes  on  into 
healthier  conditions. 

8.  Physical  exercise  usually  requires  some  modification 
during  a  course  of  bathing,  etc.  The  reaction  of  the  cooling 
processes  is  hastened  and  assisted  by  a  short  brisk  walk  ; 
rest  and  cooling  are  frequently  beneficial  after  warm  applica- 
tions. If  much  exercise  be  taken  during  a  full  course  of 
treatment,  loss  of  weight  will  result. 

9.  After  a  course  of  hydrotherapeutic  treatment,  a  change 
to  a  more  bracing  climate,  or  a  short  sea  trip,  is  often 
benelicial.  This  constitutes  what  is  known  on  the  Continent 
as  the  "  after-cure."  Patients  who  feel  exhilarated  by 
their  better  health  should  be  warned  not  to  over-exert 
themselves  and  so  induce  a  relapse. 

THE  TECHNIQUE  OF  BATHS,  PARTIAL 
AND  GENERAL. 

The  Arm  Bath. — This  is  chiefly  used  in  surgical  cases, 
in  severe  burns  and  skin  diseases  [Plate  IV),  and  requires 
no  detailed  notice  here.     ' 


36 


NATURAL     THERAPY 


The  Foot  Bath. — The  bath  itself  is  a  famihar  household 
utensil,  made  either  of  metal,  porcelain,  or  wood,  and  requires 
no  further  description  {Fig.  lo).  There  are,  however, 
many  varieties  of  application  of  the  bath,  so  far  as  the 
temperature  and  duration  are  concerned.  The  following  are 
the  most  important  : — 


Fig.  10. — An  Improved  Foot  Bath. 

1.  Cold. — Two  inches  deep,  for  thirty  minutes,  the  feet 
to  be  kept  on  the  move  all  the  time  and  rubbed  against  each 
other.  The  action  of  the  bath  is  intensified  if  the  water  is 
flowing  through  the  vessel  used,  and  thus  constantly  chang- 
ing and  always  at  the  same  temperature.  Water  of  a 
temperature  of  from  io°-i5°  C.  is  commonly  employed. 
At  the  conclusion  the  feet  should  be  well  dried,  and  the 
patient  take  a  short  walk. 

This  bath  is  a  powerful  derivative,  inducing  a  hypersemia 
in  the  vessels  of  the  feet  and  legs.  It  helps  to  relieve  con- 
gestion of  the  brain  and  viscera,  and  is  of  high  value  in 
cases  of  habitually  cold  feet.     The  general  effect  is  tonic. 

Caution. — This  bath  should  not  be  used,  nor  indeed  any 
cold  foot  bath,  in  any  bladder,  rectal,  or  ovarian  inflamma- 
tion, nor  in  sciatica. 

2.  Treading  in  cold  water,  one  inch  deep,  for  two  to  three 
minutes.  This  is  a  useful  measure  in  cases  of  cold  feet  from 
poor  circulation,  and,  given  at  bedtime,  for  insomnia. 

3.  Cold  sponging  of  feet  and  legs  over  a  bath,  one  limb  at 
a  time,  for  two  to  three  minutes.  The  feet  should  be  well 
rubbed  with  a  rough  towel  until  quite  dry,  and  a  brief  quick 
walk  taken.     The  action  is  similar  to  that  of  Nos.  i  and  2. 


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ox     THE     TAKING     OF     BATHS  87 

4.  Alternate  hot  and  cold. — Two  foot  baths  are  placed  side 
by  side,  one  containing  hot  water  at  38°  C,  and  the  other 
cold  at  18°  C.  The  patient's  leet  are  placed  in  the  hot 
water  for  half  a  minute,  and  then  shifted  to  the  cold  for  a 
like  period  ;  the  process  is  repeated  several  times,  the 
whole  bath  lasting  from  seven  to  ten  minutes,  and  finishing 
with  cold  water.  This  is  a  very  stimulating  form  of  the 
bath,  and  is  useful  in  chilblains,  in  early  Ra^^naud's  disease, 
and  in  habitually  cold  and  sweating  feet. 

5.  Hot. — Water  at  a  temperature  of  4o°-5o°  C.  is 
employed,  beginning  at  a  temperature  of  40°-42°  C,  and 
gradually  increased.  The  feet  should  be  completely 
immersed — indeed,  the  deeper  the  water  the  more  intense 
the  effect.  The  patient  sits  with  a  blanket  or  sheet  enclosing 
the  bath  and  limbs  as  high  as  the  waist.  The  duration  of 
the  bath  is  from  ten  to  twent}'  minutes,  rarely  prolonged 
to  half  an  hour.  At  the  conclusion  the  feet  and  ankles 
should  be  sponged  with  cold  water  and  brisklv  rubbed 
until  dry. 

6.  Very  hot. — Water  up  to  51°  or  52°  C,  as  hot  as  can  be 
borne,  is  used,  the  temperature  being  maintained  by  pouring 
a  cupful  of  boiling  water  against  the  side  of  the  bath  every 
two  minutes,  as  much  water  being  removed  in  advance  ; 
the  wrappings  should  be  as  little  disturbed  as  possible. 
Duration,  twenty  minutes. 

7.  Mustard. — A  breakfast-cupful  of  mustard  bran  or 
tablespoonful  of  table  mustard  is  used  for  each  quart  of 
water — of  a  temperature  of  48°-52°  C. — as  hot  as  can  be 
borne.  Duration,  fifteen  minutes,  or  less  if  uncomfortablv 
hot. 

The  ultimate  effect  of  all  these  baths  is  to  render  the 
brain  anaemic  and  quicken  the  pulse-rate.  The  hot  foot- 
bath is  par  excellence  a  derivative  measure,  relieving  brain 
and  visceral  congestions.  At  the  same  time  the  vascular 
activity  of  the  pelvic  viscera  is  increased,  and  by  means  of 
these  baths  delayed  or  suspended  menstruation  may  often 
be  brought  on.  The  value  of  a  hot  foot  bath  at  bedtime 
in  incipient  coryza  is  well  known,  its  action  being  intensified 
if  it  contain  mustard.  Whitla  also  recommends  this  in 
any  congestive  headache.  It  is  also  of  great  value,  com- 
bined with  elevation  of  the  hands,  in  epistaxis. 


38  NATURAL     THERAPY 

The  Hand  Bath. — Immersion  of  the  hands  in  cold  water 
exercises  a  much  more  powerful  influence  on  the  pulmonary 
and  cerebral  vessels  than  would  be  naturally  expected 
(Kellogg).  The  pulse  is  slowed,  and  the  pressure  in  the 
brain  arteries  lowered,  by  the  use  of  a  cold  hand  bath,  while 
the  opposite  effect  is  induced  by  a  hot  hand  bath. 

In  epistaxis  the  bleeding  is  readily  checked  if  both  hands 
be  completely  immersed  in  cold  water,  or  a  piece  of  ice  be 
held  in  the  palm  of  the  patient's  hand.  In  the  same  way 
pulmonary  haemorrhage  may  be  beneficially  influenced. 

There  seems  to  be  some  reflex  connection  with  the  genito- 
urinary organs  also,  for  the  fact  that  placing  the  hands  in  cold 
water  often  causes  the  desire  for  micturition  is  well  known. 

The  Head  Bath. — The  head  of  the  patient  should  rest 
comfortably  on  the  rim  of  a  suitable  vessel,  charged  to  within 
an  inch  of  the  brim  with  water  at  a  temperature  of  27°  C, 
which  is  continuously  taken  up  and  poured  over  the  patient's 
head  by  means  of  a  breakfast  cup.  After  fifteen  or  twenty 
minutes  of  this,  the  vessel  is  slipped  away  and  the  head  held 
up  by  the  hand.  A  towel  is  laid  loosely  over  the  hair  and 
another  is  laid  on  a  pillow  on  which  the  head  is  now  rested. 
The  patient  is  left  thus  for  half  an  hour  or  more,  if  agreeable. 

Some  little  modification  is  required  in  the  case  of  women, 
on  account  of  their  usually  long  hair.  The  face  only  should 
be  dipped  into  the  bath,  or  if  the  whole  head  be  dipped, 
special  precautions  will  be  required  in  drying,  and  the 
patient  should  stay  indoors  for  some  hours  with  the  hair 
wrapped  up  in  a  silk  handkerchief. 

The  patient  lies  on  his  back,  with  the  shoulders  raised  by 
pillows  to  the  level  of  the  edge  of  the  bath,  from  the  sharp- 
ness of  which  the  back  of  the  neck  is  protected  by  means  of 
a  pad.  The  feet  and  legs  are  well  covered  up,  with  the 
addition,  if  necessary,  of  a  hot-water  bottle. 

Should  a  regular  head  bath  not  be  available,  an  ordinary 
washstand  basin  with  an  inverted  soap-dish  in  the  middle, 
and  capped  with  a  sponge,  will  suffice.  Comfort  in  position 
is  essential,  and  care  should  be  taken  to  avoid  haste  in 
rising  from  the  supine  position. 

By  means  of  the  head  bath  anaemic  headaches  are  often 
relieved  and  sexual  excitement  allayed.  Hughes  Bennett 
recommended  this  bath  in  delirium  tremens. 


ON     THE     TAKING     OF     BATHS 


39 


Simple  head  bathing  for  a  very  few  minutes  is  often  of 
service  in  a  feverish  or  congestive  headache,  or  in  the 
headache  due  to  exposure  to  the  sun.  The  brow  and 
temples  are  sponged  with  cold  water  (i8°-20°  C.)  for  two 
to  three  minutes,  the  patient  stooping  the  while  over  the 
basin  of  water. 

The  refreshing  effect  of  the  application  of  a  cold  sponge  or 
wet  napkin  to  the  posterior  auricular  region  is  well  known 
to  the  epicurean.  The  mental  obfuscation  induced  by  a 
good  dinner  and  the  accompanying  wine  is  thus  quickly 
removed,  hence  the  name  of  "  the  alderman's  nerve," 
applied  to  the  posterior  auricular. 

The  headache  of  coryza,  and  the  feeling  of  stuffiness  in 
the  nose,  is  relieved  if  the  forehead  and  nose  be  sponged 
with  water  as  hot  as  can  be  borne,  for  a  couple  of  minutes. 

The  Leg  Bath. — A  deeper  vessel  is  used  for  this  than 
in  the  foot  bath  {Fig.  ii),  and  the  temperature  of  the  water 
will  vary  according  to  the  effect  desired. 


An  Improved  L,eg  Bath. 


Hot  leg  bath. — Water  37°-45°  C  for  ten  minutes,  followed 
by  tepid  sponging.  Mustard  may  be  added  to  enhance  the 
effect  if  there  be  no  contra-indication. 

Cold  leg  bath. — Temperature  io°-i5°  C,  for  ten  minutes. 

The  sweating  leg  bath. — The  bath  figured  above,  or  a  deep 
pail,  is  filled  to  within  three  inches  of  the  brim  with  water  at 
37°-38°  C.     The  patient  is  undressed  and  seated  on  a  chair 


40  NATURAL     THERAPY 

covered  with  a  warm  flannel  pad,  with  his  legs  in  the  bath. 
He  is  completely  enveloped  in  a  blanket,  previously  warmed 
[Plate  IV).  The  temperature  of  the  water  is  gradually  raised 
by  pouring  a  pint  of  boiling  water  into  the  bath  every  two 
minutes — against  the  side  of  the  bath — a  similar  amount 
having  been  removed  in  advance.  The  temperature  should 
be  raised  as  high  as  the  patient  can  bear — about  45^-47°  C, 
— and  the  bath  continued  for  twenty  minutes.  The  patient 
will  perspire  profusely.  At  the  conclusion  he  is  dried 
lightly  with  warm  rough  towels  and  put  to  bed  between 
blankets,  sweating  being  encouraged  by  means  of  extra 
bed-clothes  and  hot  drinks. 

This  bath  is  an  extremely  handy,  inexpensive,  and  readily 
procured  sudorific  and  derivative  measure.  It  is  always 
of  service  where  diaphoresis  is  indicated  and  the  more 
elaborate  and  modern  methods  and  apparatus  are  not 
available.  It  is  useful  in  suppressed  menstruation,  in 
dysmenorrhoea,  and  ovarian  congestion. 

The  Sitz  Bath. — The  ordinary  sitz  or  hip  bath  is  too 
well  known  to  need  much  detailed  description.  It  may  be 
made*  of  porcelain,  metal,  or  wood  {Plates  V  and  VI). 

The  best  form  of  bath  known  at  present  is  probably  that 
of  the  Fischer  Kiefer  Co.,  which  is  made  of  plated  metal 
with  an  automatic  self-emptying  arrangement,  which 
maintains  the  water  at  a  constant  level.  The  male  sitz 
bath  usually  measures  20  in.  by  15  in.  in  breadth,  and 
has  a  nearly  straight  back.  The  female  sitz  bath  is 
usually  narrower  across  the  brim,  in  order  that  the  clothing 
of  the  patient  may  be  kept  out  of  the  water,  and  undress- 
ing be  avoided  if  so  desired.  A  hot-water  can  or  tub 
is  usually  placed  at  the  patient's  feet,  and  a  wet  cloth 
around  his  head,  while  the  bath  lasts  {Fig.  12).  The  water 
should  reach  to  the  level  of  the  patient's  umbilicus,  and 
about  five  or  six  gallons  are  usually  required. 

If  the  bath  is  of  anything  but  the  briefest  duration  the 
patient  should  be  carefully  protected  from  cold  by  means 
of  a  blanket,  which  encloses  the  whole  bath,  with  his  feet 
and  legs. 

The  temperature  of  this  bath  will  vary  from  io°-45°  C, 
and  will  depend  on  whether  we  desire  it  to  be  cold  (io°-20°), 
tepid  (20°-3o''),  warm  (30°-38°),  or  hot  (40°-45°).     Many 


PL  A  TE     VI. 


General  Bath  and   Douche   Room. 


SiTz  Bath,  Nauheim  Bath,  and  Packing  Couch. 


ON     THE     TAKING     OF     BATHS  41 

people  will  be  unable  to  stand  anything  over  42*^  C.     The 

duration  will  vary  from  two  to  thirty  minutes. 

.    Kellogg  considers  that  the  flexion  of  the  limbs  entailed 

by  this  bath  interferes  with  its  eihcacy,  by  restricting  the 

circulation. 

Modus  operandi. — The  action  of  this  procedure  depends 
on  the  temperature  of  the  water  and  the  time  for  which  it 
is  kept  up.  The  pelvic  and  abdominal  viscera  are  reilexly 
stimulated  :    a  cold  bath  of  anv  duration  causes  them  to 


Fig:  12. — Sitz   Bath,  with  Friction. 

contract,  while  a  hot  bath  causes  dilatation.  In  the  reaction 
after  a  cold  bath  dilatation  in  all  probability  ensues,  but 
the  effect  of  the  cold  lasts  for  some  time  and  induces 
anaemia  of  the  viscera. 

Intestinal  peristalsis  is  stimulated  by  brief  cold  baths, 
but  long-continued  cold  baths  lessen  peristalsis. 

Varieties   of  the    Sitz    Bath  : — 

I.  Cold  sitz  bafli. — The  water  should  cover  the  groins 
and  no  more.  Wrapped  in  a  blanket  the  patient  remains 
in  it  for  ten  minutes,  the  attendant  rubbing  the  back  and 


42  NATURAL    THERAPY 

abdomen  if  at  all  chilly.  It  is  not  necessary  to  undress 
completely,  but  only  sufficiently  to  keep  the  clothing  out 
of  the  water.  The  patient  is  carefully  dried,  and  should 
take  a  short  sharp  walk  to  get  thoroughly  warm. 

2.  Tepid. — 27*5°  for  ten  minutes,  with  a  little  cold  water 
run  in  at  the  finish, 

3.  Flowing. — Cold  water  is  kept  running  through  the 
sitz  bath  all  the  time.  Duration,  two  minutes,  or  less  if  the 
cold  be  felt  too  keenly. 

4.  Dipping. — The  bath  contains  cold  water  three  inches 
in  depth,  and  the  patient  keeps  moving  up  and  down  all 
the  time.  Grasping  the  sides,  he  rises  clear  of  the  water 
and  then  sits  down  again,  and  does  this  every  second  or 
two  for  two  minutes. 

5.  With  water  as  hot  as  can  be  borne. — The  bath  is  full  of 
water  at  about  38°  C,  and  a  foot  bath  of  the  same 
temperature  is  placed  in  front  of  it.  Hot  flannel  pads  are 
placed,  one  on  the  back  of  the  bath  and  the  other  floating  in 
the  water.  Completely  undressed,  the  patient  sits  down, 
and  is  enveloped  from  head  to  foot  in  warm  blankets.  A 
cold,  wet  cloth  is  wrapped  around  his  head.  A  minute  after, 
a  pint  of  boiling  water  is  poured  gently  against  the  side  of 
the  bath  (as  in  the  sweating  leg  bath),  removing  as  much 
beforehand  by  means  of  a  cup  or  the  overflow  pipe.  The 
wrappings  must  be  disturbed  as  little  as  possible.  Add 
boiling  water  thus  every  minute  until  the  bath  is  as  hot  as 
can  be  borne  (44°-46°  C).  After  twenty  minutes  have 
elapsed  the  patient  gets  up  from  the  bath,  is  carefully  dried 
with  hot  towels,  and  put  in  bed  between  blankets.  The 
room  in  which  this  bath  is  given  should  be  comfortably  warm. 

6.  Hot  and  cold  alternate,  by  gradual  transitions. — Begin 
with  38°  C,  and  raise  the  temperature  as  high  as  can  be 
borne  (43°-46°  C).  Then  slowly  reduce  as  before,  taking 
about  two  minutes  for  each  change,  and  ten  minutes  in  all 
for  the  bath.     The  patient's  clothing  is  entirely  removed. 

7.  Hot  and  cold  alternate,  by  sudden  changes. — Two  sitz 
baths  are  used,  side  by  side,  one  containing  water  at  18°  C, 
and  the  other  hot  water  at  42°  C.  The  patient  moves 
from  one  to  the  other  every  two  minutes,  beginning  with 
the  hot  and  ending  with  the  cold  water.  The  bath  is 
continued  for  eight  or  ten  minutes. 


ON    THE     TAKING     OF    BATHS  rs 

8.  Warm  sitz  hath,  with  cold  affusion  to  the  abdomen. — The 
patient  is  seated  in  water  at  38°  C,  with  the  bath  full  to  the 
overflow  pipe.  A  pint  of  cold  water  (18°  C.)  is  poured  over 
the  lower  part  of  the  abdomen  every  two  minutes  from  a 
height  of  a  foot  or  so.  The  surface  of  the  abdomen  is 
rubbed  all  the  time,  either  by  the  attendant  or  the  patient 
himself.  The  bath  concludes  with  cold  sponging  of  the 
parts,  and  lasts  for  ten  minutes. 

9.  With  mustard. — This  bath  is  the  same  as  No.  5,  only 
a  tablespoonful  of  table  mustard  or  a  cupful  of  mustard 
bran  is  added  to  each  gallon  of  water. 

Therapeutic  Indications. — Cold  sitz  baths  of  from  two 
to  five  minutes'  duration  are  indicated  in  various  abdominal 
and  pelvic  diseases  and  affections,  such  as  ovarian  and  uterine 
neuralgia,  chronic  prostatic  congestion,  and  bladder  atony  ; 
in  chronic  gastric  catarrh,  chronic  intestinal  catarrh,  and 
hepatic  congestion  ;  in  constipation,  amenorrhoea,  and  some- 
times in  spermatorrhoea  and  impotence.  Although  the 
cerebral  activity  is  often  markedly  increased,  in  some  cases 
of  insomnia  sleep  is  induced  by  this  procedure. 

Care  must  be  taken  never  to  use  cold  sitz  baths  in  any 
acute  inflammatory  condition  of  the  abdominal  viscera,  or 
in  cystitis. 

Prolonged  cold  sitz  baths,  from  three  to  eight  minutes, 
exsanguinate  the  intestinal  surface,  and  are  useful  in 
various  diarrhoeas  and  dysentery,  in  piles  and  proctitis, 
chronic  menorrhagia  and  pelvic  congestion  (especially  if 
combined  with  hot  vaginal  douches). 

Warm  sitz  baths,  from  twenty  minutes  to  one  hour  in 
duration,  have  a  sedative  and  anodyne  effect,  and  are  useful 
in  acute  and  chronic  inflammatory  conditions,  in  constipa- 
tion, and  the  anaemia  often  associated  with  it. 

The  hot  sitz  bath  is  useful  in  restoring  suspended 
menstruation,  in  vaginismus  and  ovarian  neuralgia.  In 
renal  colic,  neuralgia  of  the  testicles,  sciatica,  tenesmus, 
and  any  painful  non-inflammatory  affections  of  the  pelvic 
or  lower  abdominal  viscera  it  is  indeed  a  powerful 
analgesic.  The  mustard  sitz  bath  is  at  all  times  a  deriva- 
tive, and  it  is  often  employed  effectually  in  amenorrhcea. 

The  cold  sitz  bath  produces  a  profound  effect  on  all  the 
bodily  functions.     There  is   lessened   activity  of  the  skin. 


44  NATURAL    THERAPY 

"  goose  flesh,"  contraction  of  the  cutaneous  vessels,  and 
slowing  of  the  pulse. 

A  hot  sitz  bath  acts  as  an  anodyne,  antispasmodic,  and 
derivative  measure.  The  pelvic  circulation  is  increased, 
and  blood  diverted  to  the  pelvic  viscera. 

The  Back  Laving. — The  patient,  partially  dressed,  or 
covered  with  a  blanket,  sits  across  a  sitz  bath  half  full  of 
cold  water,  while  the  attendant  with  a  sponge  laves  the 
entire  spine  for  five  minutes  with  : — 

1.  Cold  water. — If  the  clothing  be  removed,  the  patient 
should  be  carefully  covered  up  in  front  by  means  of  a 
specially  made  blanket  {Plate  VII). 

2.  Tepid  to  cold. — At  27°  C.  for  four  minutes,  and  cold 
for  one  minute. 

3.  Hot  and  cold  alternate. — The  water  is  run  gradually 
from  warm  (32°  C.)  down  to  cold,  and  then  up  again  to  as 
high  a  temperature  as  can  be  borne  (46°-47°  C),  and  once 
more  down  to  cold.  The  back  is  laved  for  five  minutes  in 
all. 

4.  Hot  and  cold  alternate,  with  rapid  changes  from  hot  to 
cold,  each  for  half  a  minute.  This  is  done  by  having  a 
couple  of  cans  or  buckets  side  by  side,  with  hot  and  cold 
water,  and  using  a  separate  sponge  for  each.  Duration,  five 
minutes  in  all. 

5.  With  mustard. — A  breakfast-cupful  of  mustard  bran 
(or  a  tablespoonful  of  table  mustard)  is  used  to  each  quart 
of  water,  which  should  be  as  hot  as  the  patient  can  bear 
it.  Duration,  four  minutes,  or  less  if  felt  too  acutely. 
The  bath  is  finished  with  cold  water  for  fifteen  seconds. 

The  Back  Spouting. — i.  Cold. — A  jet  of  cold  water  is 
played  up  and  down  the  whole  length  of  the  patient's 
back,  the  patient  being  partially  undressed  and  seated 
on  a  board  placed  across  the  sitz  bath.  One  minute  will 
suffice. 

2.  Warm  to  cold. — Begin  at  32°  C,  and  run  gradually  down 
in  the  course  of  a  minute  to  cold,  at  which  it  is  continued 
for  two  minutes  or  more. 

3.  Hot  and  cold  alternate. — Hot  (45°  C.)  at  first  for  half  a 
minute,  then  cold  for  half  a  minute.  Keep  changing  from 
one  to  the  other  for  three  minutes,  and  then  conclude  with 
cold. 


PLATE     VII. 


Back   Laving   or   Sponging. 


PL  A  TE     IX. 


The    Half    Bath    with    Friction. 


ON     THE     TAKING     OF     BATHS 


45 


These  are  all  tonic  bracing  applications.  The  hot  and 
mustard  applications  are  best  suited  to  the  old,  and  patients 
with  feeble  circulation.  The  back  spouting  is  only  adapted 
to  the  more  vigorous  type  of  patients. 

The  Half-Bath. — An  ordinary  shallow  household  bath 
is  used,  about  half  full  of  water  from  20°  to  30°  C,  accord- 
ing to  the  effect  we  desire  to  produce.  After  cooling 
his  head  with  water,  the  patient  enters  the  bath  and  sits 
down  so  as  to  be  about  half  immersed.  He  lowers  his 
body  for  a  moment  so  as  to  immerse  the  shoulders,  and  then 
returns  to  the  sitting  posture,  while  an  attendant  freely 
douches  the  upper  portion  of  his  body.     He  again  lowers 


Fig.   13. — ^Modern  Type  of  Set-in  Bath. 

himself  into  the  semi-recumbent  position  while  the  attendant 
briskly  rubs  the  chest,  abdomen,  and  limbs  with  bare 
hands  or  friction  gloves  {Plates  VIII  and  IX).  The  bath 
is  then  completed,  and  the  patient  wrapped  in  a  warm 
sheet  and  dried. 

This  bath  is  stimulating,  and  a  good  reaction  is  encouraged 
by  the  friction  movements  ;  generally  speaking,  the  warmer 
the  temperature  of  the  water,  the  less  the  stimulating  effect 
of  the  bath.  The  quicker  the  reaction,  the  greater  is  the 
amount  of  heat  abstracted. 

This  bath  is  of  great  service  as  an  antipyretic,  but  should 
not  be  used  for  more  than  a  very  short  period  where  the 
patient  is  weak  and  collapsed.     In  such  cases  it  is  well  to 


46  NATURAL     THERAPY 

give  the  patients  a  warm  and  even  stimulating  drink 
immediately  before  the  bath  is  administered. 

Indications.— Cool  baths  (22°-26°  C),  of  three  or  four 
minutes'  duration,  may  be  used  regularly  in  the  morning 
as  a  hygienic  measure  for  people  in  ordinary  health.  They 
may  be  combined  with  friction,  and  are  exceedingly  pleasant 
and  refreshing. 

In  diseases  of  digestive  character,  such  as  gastric  irrita- 
tion, or  atony,  or  hyperchlorhydria,  this  bath,  combined 
with  hot  and  cold  douching  to  the  abdomen,  is  exceedingly 
helpful  and  beneficial.  The  douching  can  be  carried  out 
by  the  patient  himself  by  means  of  a  tin  basin,  or  more 
efficiently  by  an  attendant. 

In  affections  of  the  spinal  cord,  etc.,  the  temperature  of 
the  water  should  be  from  28°  to  30°  C.  If  the  lesion  be  an 
irritative  one,  such  as  ataxic  paraplegia,  chorea  gravis,  or 
paralysis  agitans,  the  water  may  be  even  warmer  with 
advantage.  In  myelitis  and  other  paralytic  conditions  a 
brief  cool  bath  is  best. 

The  use  of  the  half-hath  in  typhoid  and  other  fevers. — 
Although  scarcely  within  the  scope  of  this  work,  it  may 
be  well  to  allude  briefly  to  the  extreme  value  of  the 
cooling  bath  in  typhoid,  as  advocated  by  Brand,  Barr, 
and  others. 

The  Plunge  Bath. — The  temperature  of  the  water 
should  be  cool  or  cold,  from  22°  down  to  15°  C.  The 
duration,  one  to  three  minutes.  The  bath  should  be  about 
half  full,  to  admit  of  the  patient  moving  and  splashing  freely 
without  upsetting  much  water.  This  bath  has  a  marked 
stimulating  effect  on  the  circulation  and  respiration.  The 
brief  application  of  the  cold  water  should  induce  a  quick  and 
good  reaction,  and  make  the  patient  feel  warm  and  comfort- 
able. This  effect  is  enhanced  if  the  patient  be  previously 
warmed  in  a  hot-air  bath  or  before  a  fire,  and  cold  water 
(15°  C.)  be  used.  While  thermolysis  is  somewhat  avoided 
by  this  procedure,  thermogenesis  is  proportionately  increased 
by  the  stimulus  of  the  cold. 

Therapeutic  Indications.— Cool  and  cold  plunge  baths 
are  of  service  when  general  stimulation  is  desired  without 
lowering  of  temperature.  While  primarily  stimulating  from 
the  bracing  effect  of  the  brief  exposure  to  cold  water,  they 


ON    THE     TAKING     OF     BATHS 


47 


are  secondarily  sedative ;  not  a  few  people  who  suffer  from 
insomnia  find  that  sleep  is  induced  b}^  this  bath,  particularly 
if  they  do  not  dry  themselves,  before  returning  to  bed. 

The  Full  Bath  (Cold),  or  Shallow  Bath. — This  is  now 
an  ordinary  household  bath,  six  or  seven  feet  long  by  three 
feet  wide  {Fig.  13).  The  water  is  cold  (8°-i2°  C),  and  should 
be  kept  so  by  running  in  fresh  water  all  the  time.  The 
duration  is  very  brief — not  more  than  sixty  seconds. 

The  patient,  having  previously  cooled  his  head  by  wetting 
it  under  the  tap  or  with  a  wet  towel,  completely  submerges 
the  body  once  or  twice,  and  then  gets  out.  The  bath  is 
intensely  stimulating  and  produces  a  brisk  reaction. 

The  respirations  are  much  quickened,  the  patient  often 
gasping  ;  the  circulation,  general  and  cutaneous,  is  strongly 
stimulated  {Fig.  14),  and  the  skin  markedly  reddened. 


Fig.  14. — Pulse- Tracing  :   (a)  Before,  (b)  After  a  Full  Bath. 


This  bath  is  frequently  used  as  a  sequel  to  a  vapour  bath 
or  hot  pack,  but  is  only  so  employed  when  the  patient  is 
robust. 

If  followed  by  a  half -bath  at  16^-20°  C,  this  procedure 
has  a  distinct  antipyretic  action.  The  cool  half-bath,  by 
way  of  comparison,  seems  tepid  to  the  patient. 

Therapeutic  Indications. — Where  it  is  desired  to 
strongly  stimulate  metabolism  in  cases  of  gout,  syphilis,  and 
obesity,  and  also  in  certain  cases  of  tuberculous  disease. 

For  debilitated  and  exhausted  patients  it  is  unsuitable 
and  even  harmful. 


48 


NATURAL     THERAPY 


THE    DRIP    SHEET. 


The  patient  having  previously  been  moistened  or 
wrapped  in  a  damp  towel,  and  standing  in  a  warm  shallow 
(half-inch  deep)  foot-bath,  a  sheet  (two  by  three  yards) 
folded  lengthwise  is  drawn  through  cold  water  and  wrapped 
about    him    in    the    following    manner  :    The    attendant, 

approaching  from  the 
front,  unfolds  a  portion  of 
the  folded  border,  hxes 
the  free  edge  of  the  sheet 
under  the  right  armpit, 
{Figs.  15,  16,  17),  and 
passes  it  across  the 
patient's  chest,  below  the 
left  axilla,  and  around  the 
back  and  over  the  right 
shoulder,  so  as  to  com- 
pletely envelop  him. 

The  patient's  entire 
body  is  then  vigorously 
chafed  and  smacked 
through  the  sheet.  An 
active  stimulus  is  provided 
by  the  cold,  and  also  by 
the  manipulation.  The 
skin  is  reddened  and  the 
circulation  rendered  in- 
creasingly active,  the  res- 
pirations are  quicker  and 
deeper. 

The  duration  of  the  drip  sheet  varies.  The  attendant 
should  keep  up  the  rubbing^ until  the  patient  feels  warm. 
The  effect  of  this  procedure  is  enhanced,  and  a  good  reaction 
more  quickly  attained,  if  the  patient  has  a  few  minutes' 
warming  in  the  hot-air  cabinet  or  Turkish  bath  before  the 
sheet  is  applied. 

The  use  of  the  shallow  warm  foot-bath  is  of  particular 
importance  when  the  patient  is  weak  or  sensitive.  On  a 
good  reaction  being  established,  he  is  thoroughly  dried  and 
allowed   to   rest    for  some  time  on  a  couch   or  bed,   well 


Fie.  15. — The  Drip  Sheet. 


ON     THE     TAKING     OF     BATHS 


49 


covered.     As  a  rule  a  good  reaction  is  sooner  obtained  if 
cold  water  be  used,  rather  than  tepid  or  warm. 

Very  little  antipyretic    effect   is    produced  by  the  drip 
sheet,  but   if  it  is  desired  to   cause  heat  abstraction,  the 
sheet    should    be    freely    re-wetted 
with  cold  water  and  the  bath  some- 
what prolonged. 

This  application  may  be  varied 
in  several  ways.  The  sheet  may 
be  wrung  out  of  cold  water  before 
application,  and  applied  merely 
moist,  constituting  the  "  cold  rub"  : 
given  in  this  way  it  is  a  milder  and 
less  stimulating  application  ;  or  it 
may  be  preceded 
by  a  hot  sheet, 
wrung  out  of  water 
at  40°  C,  and 
applied  for  half  a 
minute.  In  the 
case  of  delicate 
and  bedridden 
patients,  what  is 
known  as  the 
''partial  rub'''  may 
be  employed.  A 
small  sheet  is  used, 
dealt  with    in  turn,  care 


and  each  limb   aeait  witn    m 
being  taken  to  keep  the  rest  of  the  body 
warm.     This  last  is  an  excellent  substitute 
for  the  half-bath  in  febrile  conditions. 

General  Indications.  —  The  drip 
sheet  is  a  general  stimulant  and  invigor- 
ating procedure,  improving  the  circulation 
and  increasing  metabolism.  It  is  of 
service  in  catarrhal  conditions  of  the 
gastro-intestinal  tract,  feeble  circulation, 
and  defective  metabolism. 

Caution. — It  should  not  be  employed  in  patients  who 
show  arteriosclerosis,  in  exophthalmic  goitre,  in  the  highly 
nervous,  or  persons  suffering  from  skin  inflammations- 

4 


Fig.  16. — The  Drip  Sheet. 
Further  stage. 


Fig.  17. — Patient  com- 
pletely enveloped. 


50  NATURAL    THERAPY 

DOUCHES. 

A  douche  consists  of  a  single  or  multiple  column  of  water 
directed  against  some  portion  of  the  body.  The  three  main 
factors  in  this  procedure  are  : — 

1.  Temperature  of  the  water  employed,  which  ranges 
from  10°  to  40°  C. 

2.  The  pressure  of  the  water,  which  ranges  from  ten  to 
sixty  pounds  per  square  inch,  but  is  usually  about  thirty 
pounds.  More  than  this  is  often  unpleasant  and  may  be 
unsafe.  The  water  is  usually  projected  under  pressure,  or 
a  mechanical  stimulus  may  similarly  be  obtained  by  allowing 
it  to  fall  from  a  height  on  to  the  patient. 

3.  A  third  factor  is  the  volume  of  the  douche,  or  in  other 
words,  the  pressure  will  vary  with  the  size  of  the  orifice 
through  which  the  water  is  projected.  The  orifice  is 
commonly  about  half  an  inch  in  diameter,  but  it  may  be 
filiform  ;  or,  in  the  descending  gravity  douche,  a  full  inch  and 
a  half  in  diameter.  The  pipe  of  supply  should  be  at  least 
one  and  a  half  inches  in  diameter,  and  have  an  independent 
and  separate  connection  with  hot  and  cold  water  supplies. 

With  the  douche  should  be  connected  a  reliable  pressure 
gauge  and  thermometer.  Where  it  is  proposed  to  use  the 
vapour  douche,  a  steam-pipe  with  suitable  nozzle  must  be 
also  available. 

The  best  connection  apparatus  are  those  of  Kellogg  and 
the  Fischer  Kiefer  Co.,  of  Zurich.  Whatever  appliance  is 
used,  it  is  in  the  first  degree  essential  that  accuracy  and 
precision  of  dosage,  as  regards  temperature  and  pressure, 
are  not  only  possible,  but  easy  to  obtain. 

The   chief  varieties   of  douche  are   the   following  : 

The  Horizontal  jet  ; 

The  Percussion  douche  ; 

The  Rain  douche,  horizontal  or  vertical ; 

The  Fan  douche ; 

The  Needle  bath  ; 

The  Scotch  douche  ; 

The  Filiform  douche. 
Local  douches  may  be  applied  to  the  lungs,   liver,   or 
spleen  (that  is  to  say,  the  skin  surface  over  them),  to  the 
abdomen  or  perineum. 


ON     THE     TAKING     OF     BATHS  oi 

Modus  operandi. — The  douche  is  one  of  the  most  power- 
fully stimulating  procedures  in  the  range  of  hydrothera- 
peutics.  Its  actual  effects  will  depend  on  the  temperature 
of  the  water  employed,  its  pressure,  duration  of  the 
application,  form  and  size  of  the  stream,  the  region  to 
which  it  is  applied,  and  the  extent  of  its  application. 

By  the  use  of  the  douche  the  heart  is  markedly  stimulated, 
with  resultant  quickened  circulation,  and  the  flow  of  lymph 
is  likewise  accelerated,  as  in  general  massage.  A  rapid  and 
powerful  reaction  is  induced.  The  cold  douche  is  a  powerful 
tonic,  and  the  Scotch  douche  and  alternate  hot  and  cold 
douche  are  very  powerful  excitant  applications. 

The  Horizontal  Douche. — This  is  the  most  useful  and 
probably  most  commonly  employed  form  of  douche.  It 
may  be  in  the  form  of  a  single  jet  {Fig.  i8),  or  the  jet  may 


iS.  —  Horizontal   Douche. 


be  broken  and  spread  out  in  fan-like  fashion  {Plate  X). 
The  usual  size  of  the  nozzle  is  half  an  inch  in  diameter.  The 
force  of  the  jet  may  be  varied  by  use  of  the  operator's  finger 
at  the  nozzle. 

Care  is  always  necessary  not  to  project  the  water  under 
too  great  pressure,  especially  in  the  case  of  nervous  subjects. 

The  Percussion  Douche. — This  is  a  special  form  of 
douche,  by  means  of  which  a  water  column  of  any  desired 
form  may  be  obtained,  from  a  widely  scattered  shower  of 
large  drops,  to  a  fusillade  of  water  bullets,  which  Kellogg 


52  NATURAL     THERAPY 

likens  to  the  discharge  of  a  Gathng  gun  (see  shape  of  nozzle 
in  Fig.  19).  The  pressure  under  which  the  water  is  pro- 
jected is  higher  than  in  the  ordinary  douche,  and  a  stinging 
sensation  is  produced  as  the  water  strikes  the  patient's 
skin  {Plate  XI). 


I'lg.  19. — Kellog^'s  Nozzle. 

One  of  the  advantages  of  this  application  is  that  the 
powerful  stimulating  effect  of  the  percussion  allows  the 
use  of  water  of  a  higher  temperature  than  would  be  suitable 
in  the  ordinary  douche,  and  by  many  patients  who  are 
intolerant  of  cold  water  this  is  much  appreciated. 

The  Scotch  Douche. — ^This  consists  in  the  alternate 
application  of  the  hot  and  cold  horizontal  douche.  The 
hot  water  lasts  for  from  one  to  four  minutes,  and  the  cold 
is  continued  for  about  ten  to  thirty  seconds.  The  applica- 
tion may  be  general  or  local,  as  in  the  treatment  of  sciatica. 
The  derivative  effect  of  the  application  of  the  hot  water  is 
greatly  intensified  by  the  subsequent  cold  water. 

The  Rain  Douche. — This  is  a  common  bathroom 
appliance  {Fig.  20).  The  water  is  projected  through  a 
watering  "  rose,"  or  perforated  disc  of  varying  size,  falling 
upon  the  patient  in  a  number  of  fine  streams. 


Fig.  20. — The  "  Rose  "  for  Rain  or  Spray  Douche. 

The  pressure  of  the  water  is  lower  in  this  application,  and 
the  reaction  follows  more  slowly  than  after  the  horizontal  jet. 

This  bath  was  much  prescribed  by  Priessnitz,  and  Kellogg 
regards  it  as  an  indispensable  part  of  a  completely  equipped 
hydrotherapeutic  estabhshment. 


PLATE    X. 


The   Broken    Horizontal   Jet  Douche. 


PLATE    XI, 


The  Horizontal  Percussion  Douche. 


ON     THE     TAKING     OF     BATHS 


53 


Combination  Needle  and  Douche  Bath. — This  consists 
of  a  vertical  cage,  constructed  of  tiers  of  circular  tubing 
supported  by  uprights,  and  pierced  with  innumerable  pin- 
holes, through  which  the  douche  is  projected  upon  the 
patient  standing  within  {Plate  XII).  The  pipes  con- 
veying the  hot  and  cold  water  meet  in  a  mixing  box,  in 
which  a  thermometer  enables  the  operator  to  regulate  the 
temperature  to  any  desired  degree.  This  bath  is  commonly 
combined  w4th  the  preceding. 

The  Filiform  Douche. — In  this  the  jet  of  water  is 
horizontal,  and  issues  from  an  exceedingly  small  opening, 
capillary  in  character.  The  water  is  forced  under  great 
pressure,  and  becomes  a  cloud  a  short  distance  from  the 
apparatus.  This  douche  may  be  applied  for  any  time  up 
to  ten  minutes,  and  is  strongly  counter-irritant  in  action. 
It  may,  indeed,  even  induce  bleeding. 

Therapeutic  Indications  for  Douches. — The  cold 
douche  is  a  tonic  procedure  of  the  highest  value  ;  it  is  both 
alterative  and  restorative  [Fig.  21).    Under  its  influence  "  the 


Fig.  21. — Pulse- Tracing:   (a)  Before,   [h)  After  a  Spray  Douche. 

individual  begins  to  live  a  more  vigorous  life,  physically, 
mentally,  and  we  may  say  even  morally  "  (Kellogg).  It  is 
of  value  in  most  forms  of  cardiac  disease,  in  rheumatism, 
and  neuralgia.  Neurasthenia,  chlorosis,  and  all  the  curable 
forms  of  anaemia,  are  markedly  benefited  by  it,  as  also 
are  various  dyspeptic  conditions  and  chronic  alcoholism. 

It  should  not  be  used  in  acute  or  chronic  nephritis  or  in 
badly  compensated  cardiac  disease. 


54 


NATURAL    THERAPY 


The  Scotch  douche  is  of  extreme  value  in  various  paretic 
conditions,  in  sciatica,  neuralgia,  gastralgia,  and  lumbago. 
The  cold  or  alternate  douches  are  also  useful  in  various 
sexual  disorders,  such  as  amenorrhoea,  dysmenorrhoea, 
sexual  neurasthenia,  and  impotence.  The  combined  needle 
and  rain  bath  is  a  morning  rouser  and  refresher  par 
excellence.  The  filiform  douche  is  indicated  wherever 
counter-irritation  is  required,  as  in  sciatica,  lumbago,  and 
chronic  rheumatism. 

The  Aix  Douche,  or  Massage  Douche,  is  a  most 
valuable  balneological  agent,  and  is  extensively  used. 

The  patient  is  seated  on  a  wooden  stool,  or  reclines  on  a 
board,  and  a  continuous  needle  spray  is  directed  against 
the  spine,  while  massage  is  administered  by  one  or  more 
attendants  under  a  warm  douche,  conveyed  by  a  flexible 


FiK. 


The  Aix  Douche  with  Two  Attendants,  as  at  Aix. 


tube  passing  over  the  shoulder  of  the  masseur  {Fig.  22  and 
Plate  XIII),  and  playing  between  his  hands.  This  may  be 
followed  by  a  local  hose  douche,  and  the  bath  terminates 
with  a  needle  spray,  warm  at  first,  and  graduated  slowly  to 
tepid,  cool,  or  cold,  according  to  the  requirements  of  the 
particular  case.  The  duration  of  the  bath  is  twenty 
minutes.  It  is  useful  in  a  variety  of  affections,  the  chief 
of  which  are  chronic  gout  and  the  gouty  state  ;     chronic 


PLATE     Kill. 


The   Aix    Douche. 


ON     THE     TAKING     OF     BATHS  55 

rheumatic  arthritis,  lumbago,  and  sciatica ;  arthritis 
deformans ;  in  toxaemia  from  high  hving  with  sedentary 
habits  ;  in  cases  of  brain  fag  from  too  assiduous  work  ; 
in  obesity  ;  in  heart  disease  of  peripheral  origin  ;  and  in 
many  other  disorders. 

The  Vichy  Massage  Douche  resembles  the  Aix  douche 
very  closely,  with  some  modification  of  procedure.  The 
patient  lies  in  a  recumbent  position  on  an  india-rubber  air 
mattress,  while  massage  is  administered  under  a  spray 
douche  projected  from  a  series  of  brackets,  pierced  with  pin- 
holes, suspended  over  the  table  [Plate  XVI).  The  duration 
of  the  bath  is  twenty  minutes,  and  it  terminates  with  a 
needle  spray.  A  preliminary  steam  bath  is  often  given  and 
free  perspiration  induced  before  the  massage  is  started. 


Fig.  23.— Pulse- Tracing:   (a)  Before,  (6    After,  a  Vichy  Douche. 


56 


CHAPTER   IV. 

THE   TECHNIQUE   OF   COMPRESSES. 
PACKS,   POULTICES,    ETC. 

THE    WET    COMPRESS. 

npHE  wet  compress  (or  Umschlag  of  Priessnitz)  consists 
^  of  a  swansdown  or  linen  fabric  wrung  out  of  water  of 
varying  temperature  and  applied  to  the  surface  of  some 
part  of  the  body.  The  compress  is  usually  applied  with  a 
covering  of  some  dry  and,  for  choice,  rather  impermeable 
material,  to  prevent  loss  of  heat  by  evaporation.  Unless  so 
covered,  a  warm  compress  will  rapidly  become  cold,  and 
any  compress  dry.  Flannel  does  best  as  a  covering,  rubber 
fabrics  being  too  impermeable,  and  as  a  rule  preventing 
evaporation  too  completely. 

The  action  of  a  cold  compress  is  somewhat  obscure. 
Schade,  a  German  physician,  has  recently  explained  it 
from  the  point  of  view  of  the  osmotic  pressure  of  the  tissues 
and  tissue  fluids.  The  osmotic  pressure  of  a  solution  may 
be  said  to  be  the  pressure  which  dissolved  substances  exert 
on  the  molecular  surface  of  the  fluid  in  the  endeavour  to  increase 
the  latter.  This  pressure  may  be  very  considerable.  In 
health,  the  osmotic  pressure  of  human  blood  serum  is 
constant,  and  is  about  yh  atmospheres. 

Variations  of  osmotic  pressure  may  be  expressed  in 
another  way  by  stating  the  lowering  of  the  freezing  point 
of  the  solution  under  examination.  Blood  serum  has  a 
freezing  point  depression  of  0'56°  to  0-57°  C.  (briefly 
expressed  as  A).  The  endeavour  on  the  part  of  the  body 
to  keep  this  pressure  at  a  constant  level  is  spoken  of  as 
the  "  isotonic  balance  "  of  the  blood  and  tissues. 

In  inflammatory  conditions  the  osmotic  pressure  is 
changed  and  the  isotonic  balance  lost.  In  order  to  under- 
stand the  conditions  affecting  an  inflamed  area,  we  may 
analyze  such  a  simple  condition  as  a  boil.  In  this  the 
central   pustule   is   at   abnormally   high   osmotic   pressure, 


COMPRESSES  57 

ranging  between  o*6°  C.  and  o-8°  C,  and  may  even  rise  to 
i'4°  C.  Passing  outwards,  one  comes  to  the  hyperaemic  zone, 
in  which  the  pressure  is  still  too  high,  but  is  increasingly 
lower  the  further  we  go  from  the  central  pustule.  Outside 
this  is  the  area  of  manifest  oedema,  which  has  a  pressure 
varying  from  about  -75°  C.  close  to  the  hyperaemic  zone, 
to  -56°  C,  which  is  the  pressure  of  normal  tissues.  The 
importance  of  this  change  in  pressure  is  realized  when 
one  learns  that  the  volume  of  a  cell  diminishes  as  the 
osmotic  pressure  of  the  fluid  in  which  the  cell  is  suspended 
is  raised  above  that  of  the  cell  itself.  Thus  a  red  blood 
corpuscle  loses  about  one-quarter  of  its  volume  when  sus- 
pended in  a  1*5  per  cent  solution  of  sodium  chloride 
(A  equals  -0-9°  C.)  compared  with  a  cell  suspended  in  0-9 
percent  solution  of  sodium  chloride  (A  equals  -o'56°C.). 
Next,  as  is  well  known,  the  structure  of  a  cell  is  ma- 
terially altered  b}^  suspension  in  a  fluid  of  higher  osmotic 
pressure  than  the  cell  itself.  Red  cells  lose  their  disc  shape 
and  become  spherical  when  kept  in  i-5  per  cent  solution 
of  sodium  chloride.  Correspondingly,  the  function  of  a 
cell  suffers  when  the  isotonic  balance  is  lost.  This  can  be 
measured  by  watching  the  phagocytic  power  of  leucocytes 
suspended  in  a  saline  solution  of  varying  strengths. 
Clinicall}^  it  is  found  that  when  the  osmotic  pressure  of 
a  part  is  raised,  the  part  has  undergone  an  injury,  and 
an  inflammatory   reaction   results. 

Isotonic  solutions  may  be  injected  into  the  tissues  with- 
out any  disturbance  of  a  pathological  nature,  but  pain 
invariably  results  if  the  solutions  be  hyper-isotonic.  This 
statement  does  not  apply,  of  course,  to  substances  which 
are  escharotic,  or  possess  corrosive  action  on  the  tissues 
with  which  they  are  brought  into  contact. 

The  osmotic  pressure  of  the  tissue  fluids  thus  plays  an 
important  part  in  the  process  of  inflammation.  The 
Priessnitz  application  causes  a  reactive  h\'perasmia,  and 
thus  tends  to  re-establish  the  balance  of  osmotic  pressure. 
Schade  considers  that  while  the  compress  possesses  no 
special  action  on  the  area  of  hyperaemia,  i.e.,  the  pustule 
and  its  immediate  vicinity,  it  yet  converts  the  local  aUcTemia 
of  the  cedematous  zone  into  a  local  hvper?emia.  The 
result  of  the  increased  circulation  through  this  zone  is  to 


58  NATURAL    THERAPY 

heighten  the  lymph  circulation  centrifugally,  thus  getting 
rid  of  the  products  of  inflammation  rapidly  or  rendering 
theni  harmless  by  neutralization  with  the  various  substances 
in  the  lymph  or  serum. 

Hot  compresses  just  covering  the  acutely  inflamed  area 
rather  increase  the  pain,  while  those  reaching  over  the  whole 
of  the  area  affected  allay  pain  rapidly  ;  further,  ring- 
shaped  fomentations  just  covering  the  area  surrounding 
the  central  inflammatory  area  also  rapidly  allay  pain. 

The  duration  of  a  compress  will  depend  on  the  effect 
desired.  Generally  speaking,  cold  compresses  are  renewed 
as  soon  as  they  become  warm,  and  hot  compresses  as  soon 
as  they  become  cool.  If  cold  compresses  be  left  on  until 
they  become  warm,  they  act  as  poultices  and  stimulate 
inflammatory  changes.  Compresses  dry  more  rapidly  on 
patients  with  brisk  circulations  and  hot  dry  skins  than  in 
those  with  feeble  circulation  and  who  are  in  an  asthenic 
or  cachectic  condition.  A  maximum  stimulating  effect 
may  be  obtained  when  hot  and  cold  compresses  are  applied 
alternately  to  any  part  of  the  body  ;  the  circulation  in  the 
part  is  increased  and  the  local  metabolism  markedly 
stimulated. 

Therapeutic   Indications. 

Cooling  compresses  are  useful  in  all  local  pathological  con- 
ditions of  an  inflammatory  nature,  and  aid  in  the  removal 
of  hypersemia  or  congestion,  and  in  the  relief  of  pain. 

Warm  compresses  promote  suppuration  and  increase 
local  tissue  changes  and  the  absorption  of  morbid  products. 
They  have  a  local  antispasmodic  action,  and  often  relieve 
the  pain  of  neuralgia,  rheumatic  joint  pains,  etc. 

THE  VARIOUS  COMPRESSES  IN  USE. 
The  Head  Compress. — This  is  a  well-known  application, 
and  one  of  great  service  in  various  congestive  conditions  of 
the  brain  and  meninges.  The  compress  is  applied  either 
to  the  top  or  the  back  of  the  head,  and  in  the  latter  case 
the  back  of  the  neck  is  included  in  the  application.  If 
necessary,  the  whole  face  and  scalp  may  be  treated 
together.  It  must  be  borne  in  mind  that  a  cold  application 
to  the  forehead  will  cause  collateral  hyperaemia  of  the  brain, 
while   one   over   the  jugular  region   will   tend   to  cerebral 


COMPRESSES 


59 


anaemia.  A  brief  hot  compress  will  act  in  the  same  way. 
Headaches  of  a  neuralgic  character  are  often  relieved  by 
this  compress.  In  febrile  and  congestive  headaches  cold 
compresses  afford  most  relief.  The  head  should  be  carefully 
dried  after  the  compress  has  been  removed  {Fig.  24). 


Fig.   24. — Head   Compress. 

Throat  Compresses. — These  are  very  commonly  employed 
domestically,  but  are  very  seldom  correctly  applied,  for 
the  usual  method  is  to  fold  a  handkerchief  into  a  narrow 
bandage  and  then  wind  it  round  the  neck  like  a  collar 
or  muffler.  So  applied  it 
rapidly  becomes  useless,  for 
it  is  soon  displaced  from  its 
original  position  by  the 
patient's  movements,  and  air 
is  allowed  to  enter.  The 
proper  mode  of  application 
varies  with  the  condition  to 
be  dealt  with  {Fig.  25).  In 
any  tracheal  or  laryngeal 
trouble,  one  end  of  the 
bandage  should  be  wetted, 
and  covered  with  the  other, 
which  is  dry,  to  delay 
evaporation  ;  or  a  wetted  linen  handkerchief  should  be 
applied  and  covered  with  another,  preferably  of  silk,  and 
larger  in  size  than  the  under  one. 


Throat  Compress. 


60 


NATURAL    THERAPY 


In  affections  of  the  tonsil  and  pharynx  the  appHcation 
should  be  made  as  follows  : — 

A  piece  of  swansdown  calico,  long  enough  to  reach  from 
ear  to  ear  passing  underneath  the  chin,  is  folded  into  a 
4-layer  compress.  A  bandage  of  flannel  8  in.  by  24  in., 
provided  with  a  slit  for  either  ear,  is  also  made  :  these 
are  fitted  by  actual  measurement  to  each  patient.  The 
calico  compress  is  now  wrung  out  of  water  at  15°  C,  and 
laid  on  the  flannel  bandage  which  is  to  act  as  a  cover. 
The  wet  compress  being  placed  under  the  chin,  the  flannel 
bandage  is  now  unrolled  from  the  top  of  the  head,  on  the 
right,  the  ear  being  allowed  to  come  through  the  slit,  and 
then  carried  underneath  the  chin  and  up  the  left  side  {Fig. 
27).     The  whole  compress  is  secured  by  means  of  safety 


Fig.  26. — The  Kellogg  Compress. 


Fig.  27. — Compress  for  Tonsils  and  Pharynx. 


pins,  care  being  taken  that  while  it  is  sufficiently  tight  it 
is  not  uncomfortably  so.  A  hot  compress  applied  for 
twenty  minutes,  and  then  followed  by  a  cool  one,  will  do 
good  in  many  throat  inflammations.  If  suppuration  has 
started,  as  for  instance  in  Ludwig's  angina,  the  hot 
compress  will  encourage  the  suppuration  and  tend  to  bring 
it  to  the  surface.  In  early  inflammatory  conditions,  a  cold 
compress  will  often  go  far  to  subdue  and  check  the 
inflammation. 

The  Chest  Compress. — A  pad  of  towelling  or  swansdown 
calico,  8-folds  thick,  is  wrung  out  of  cold  water  (iced  if 
desired)  and  applied  to  the  chest  for  twenty  minutes.  This 
is  covered  by  a  flannel  cross-binder,  which  passes  over  the 


COMPRESSES 


61 


patient's  shoulders  and  is  finally  fixed  by  a  tape  {Fig.  28). 
After  the  application  is  completed,  the  patient  is  carefully 
dried  and  rubbed  with  a  rough  towel.  In  pleurisy  of  a  dry 
and  painful  character,  this  compress  is  often  very  soothing 
to  the  patient  ;  it  is  also  helpful  in  pericarditis  and  cardiac 
excitement.  In  all  cases  of  haemoptysis  it  is  a  valued  and 
serviceable  application.  Care  must  be  taken,  however, 
not  to  employ  it  in  cases  where  there  is  presumably  marked 


Fig.  28. — Chest  Compress. 

fatty  change  in  the  myocardium  associated  with  cyanosis, 
pulse  irregularity,  and  restlessness  on  the  part  of  the  patient 
(Kellogg). 

Cooling  Trunk  Compress. — A  small  blanket,  no  broader 
than  will  reach  from  armpit  to  hip,  is  spread  across  the  bed, 
with  a  waterproof  sheet  of  like  size  beneath.  Upon  these 
is  laid  a  cotton  sheet  wrung  out  of  cold  water,  6-  to  8-folds 
thick,    of    nearly    the    same    breadth,    long    enough    to 


62 


NATURAL     THERAPY 


embrace  -  the  trunk  with  the  arms  excluded,  and  well 
overlapped  in  front.  On  this  the  patient  lies  down 
{Fig.  29),  and  the  sheet  is  brought  round  and  tucked 
tightly  underneath  the  flanks,  each  side  in  turn,  the 
blanket  in  like  manner,  and  the  waterproof  over  all.  A 
hot-water  bottle  to  the  feet  and  a  cold  cloth  to  the  head 
are  then  applied,  and  the  patient's  lower  extremities 
warmly  covered  up. 

This  application  exercises  a  markedly  antipyretic  effect, 
especially  if  frequently  renewed.     In  febrile  conditions  in 


Fig.  29. — Compress  for  Trunk. 

which  drugs  seem  to  have  very  little  effect  on  the  pyrexia, 
this  application  will  frequently  bring  the  temperature 
down  several  degrees  in  a  few  hours. 

Most  patients  say  they  find  the  compress  very  comforting, 
and  indeed  it  is  a  most  convenient  and  valuable  therapeutic 
agent.  In  the  feverishness  of  children  due  to  some  gastric 
disturbance  it  is  especially  valuable,  and  the  writer  has 
found  it  of  service  in  acute  pneumonia. 

Although  the  antipyretic  action  is  enhanced  by  frequent 
renewal,  in    many  cases  it  may  be    left    on    for    four    or 


COMPRESSES  m 

five  hours,  or  even  all  night,  without  changing.  Hyperaemia 
is  induced  on  the  surface  of  the  abdomen,  and  sleep  is 
encouraged  by  the  resultant  cerebral  anaemia. 

The  Abdominal  Bandage  (or  Neptune's  Girdle). — This 
is  a  piece  of  swansdown  calico,  3  feet  long  by  8  to  10  inches 
wide.  A  length  sufficient  to  go  one  and  a  half  times  round 
the  patient's  abdomen  is  immersed  in  water,  wrung  out, 
and  wrapped  round  the  part.  The  dry  portion  is  then 
folded  over  the  wet,  so  as  to  prevent  undue  evaporation, 
and  may  be  further  covered  by  a  waterproof  cloth  of 
some  sort,  the  whole  application  being  secured  by  means 
of  tapes. 

This  bandage  can  be  worn  quite  well  whilst  the  patient, 
if  a  man  goes  about  his  ordinary  daily  occupation  ; 
but  is  inconvenient  for  women  owing  to  the  corset. 
It  is  an  application  of  some  value  in  various  digestive 
disorders,  and  is  generally  of  a  soothing  nature,  though 
nervous,  irritable  subjects  often  dislike  it,  and  are  kept 
awake  at  night  by  it. 


^^ 


Fig.  30. — Joint  Compress. 


Circular  Joint  Compresses. — These  are  made  of  strips 
of  swansdown,  18  inches  by  6  inches,  wrung  out  of  water 
and  applied  to  the  joint  to  be  treated,  covered  with  flannel 
or  waterproof.  They  are  useful  in  various  rheumatic  joint 
affections  {Fig.  30). 

The  Electro-thermal  Compress  (or  Electric  Thermo- 
phore).— This  was  invented  by  Cerruti,  and  has  for  a  number 
of  years  been  in  use  in  Italy,  especially  in  the  hospitals  at 
Turin.  The  apparatus  is  really  a  compress  consisting  of 
light,  flexible,  and  incombustible  pads,  containing  electrical 
heating  apparatus  in  the  form  of  threads  of  asbestos  around 


64 


NATURAL     THERAPY 


which  are  wound  fine  coils  of  resistance  wire  {Fig.  31). 
These  threads  are  arranged  in  spirals  between  the  folds  of 
the  compress,  are  perfectly  insulated,  and  are  attached  at 
one  end  of  the  pad  to  thicker  wires  which  can  be  connected 
with  the  ordinary  electric  supply,  so  that  when  the  current 
is  turned  on  the  compress  is  heated  uniformly  throughout. 
The  amount  of  current  passing  is  regulated  by  means  of 


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is 

1 

1 

1 

, 

;:;;:■■ 

i 

Fig.  31. — Electro-thermal  Compress. 


Fig.  32. — The  Compresses 
applied. 


a  small  rheostat,  and  any  desired  temperature  up  to  about 
150°  C.  can  be  arranged  for.  There  is  a  removable  outside 
cover  for  each  cpmpress,  which  can  be  periodically  cleaned. 
These  compresses  are  extremely  convenient  and  inex- 
pensive, but  of  course  can  only  be  used  in  houses  where 
the  electric  current  is  laid  on.  Placed  in  contact  with  the 
skin,  they  are  an  excellent  medium  for  the  application  of 
dry  heat ;    while  by  inserting  a  piece  of  damp  cloth  between 


PACKS 


65 


the  compress  and  the  skin,  a  poultice  is  formed  which  can 
be  maintained  at  any  desired  temperature  for  an  indefinite 
length  of  time. 


THE    WET    PACK. 

This  is  apphed  in  the  following  manner.  A  blanket 
2^  yards  square  is  placed  on  a  suitable  couch  or  stretcher 
bed,  and  upon  this  is  laid  a  coarse  linen  sheet  wrung  out  of 
water  at  i6°  to  i8°  C. 

The  patient,  around  whose  head  a  cool  compress  has  been 
arranged,  now  lies  down  on  the  sheet,^^which  is  carefully 


Fig.  33. — Application  of  Wet  Pack. 


and  smoothly  wrapped  about  him  in  the  following  manner  : 
His  arms  are  raised  above  his  head,  and  one-half  of  the 
sheet  is  drawn  across  his  body,  its  upper  portion  tucked 
alongside  the  trunk  and  the  lower  between  the  lower  limbs. 
The  arms  are  brought  down  to  the  side  of  the  body  {Fig. 
33),  the  other  half  of  the  sheet  being  arranged  so  as  to  in- 
clude them  and  its  border  tucked  in  along  the  opposite 
side  beneath  the  arms  and  between  the  legs,  in  such  a 
manner  that  the  two  skin  surfaces  do  not  come  into  contact. 
The  blanket  is  then  brought  together  at  all  points, 
particular  care  being  taken  to  cover  in  the  neck  and 
shoulders  {Fig.  34). 

5 


66 


NATURAL     THERAPY 


The  blanket  is  usually  equal  to  i|-  times  the  circumference 
of  the  patient's  trunk,  and  serves  to  keep  in  the  heat.  It 
is  necessary  to  wrap  it  pretty  firmly  round  the  patient  and 
to  restrict  movements  of  the  limbs  ;  at  the  same  time  we 
must  avoid  rendering  him  uncomfortable  or  giving  him 
pain.  The  feet  should  be  kept  warm  by  means  of  a 
hot-water  bottle  or  the  previous  application  of  friction. 

Action. — The  whole  body-surface  is  at  first  markedly 
stimulated  by  the  cold  sheet,  and  quickened  heart  action 
and  respiration  result.  Usually  the  sense  of  cold  disappears 
in  about  a  quarter  of  an  hour,  and  the  patient  becomes 


Fig.  34. — The  Wet  Pack  complete. 

warm  and  comfortable.  The  peripheral  vessels  dilate, 
the  pulse  slows,  and  the  patient  feels  drowsy,  often  falling 
asleep.  Later,  perspiration  may  take  place,  depending  on 
the  duration  of  the  pack,  which  will  vary  according  to  the 
effect  we  desire  to  produce.  If  the  pack  be  changed 
frequently  a  marked  antipyretic  effect  is  obtained.  The 
warm  reaction  is  slower  each  time  the  pack  is  repeated. 


THE    DRY    PACK. 

This  application  is  similar  to  the  wet  pack,  only  the  wet 
sheet  is  omitted  and  a  soft  thin  blanket  or  flannel  sheet  is 
used  in  its  place,  covered  on  the  outside  with  a  thick  blanket. 


PACKS 


67 


Indeed,  very  often  merely  a  single  thick  blanket  is  employed. 
The  patient  is  very  completely  enveloped,  and  a  hot-water 
bottle  placed  at  the  feet  {Fig.  35). 

Reddening  of  the  skin  is  rapidly  induced  by  the  irritation 
ofjthe  blanket,  and  the  body  soon  becomes  warm.     Perspira- 


%  ^1  'f /'!a=^''''nip^TTWfT|jfpf(^'^  v^^ 


Fig.  35.— The  Dry  Pack. 


tion  appears  with  a  rapidity  which  varies  with  the  individual, 
on  an  average  in  one  and  a  half  hours,  and  sooner  than  in 
the  wet  pack.  The  body  temperature  rises,  the  tongue 
becomes  dry,  the  pulse  and  respiration  quicken,  while  the 


Fig.  36. — Electric  Sweating  Mattress. 


head  feels  somewhat  full  and  congested.  Considerable 
discomfort  is  experienced  by  the  patient  until  perspiration 
is  actually  established.  The  onset  of  perspiration  may  be 
hastened  if  certain  preliminary  measures  be  taken.  One 
method  is  to  place  the  patient  in  a  hot  full  bath   (40°  C.) 


68  NATURAL     THERAPY 

for  ten  minutes  before  applying  the  pack.  This  is  useful 
svhen  the  patient  is  suffering  from  chronic  granular  kidneys 
associated  with  high  blood-pressure.  Another  method  is 
to  get  the  patient  to  put  on  very  warm  clothing  and  engage 
himself  in  active  muscular  exertion,  such  as  swinging 
Indian  clubs,  for  ten  minutes  or  so,  and  then  put  him  in 
the  pack.  The  pack  may  also  be  made  more  active  and 
efficient  if  the  patient  lies  on  an  electric  sweating  mattress 
{Fig.  36),  in  which  heat  is  generated  by  the  resistance  of 
thin  conducting  wires. 

While  perspiration  is  going  on,  cold  water  should  be  freely 
drunk,  and  on  the  conclusion  of  the  pack  the  patient  should 
be  well  lathered  down  and  given  a  cold  spray  douche. 

Needless  to  say,  such  a  method  of  inducing  diaphoresis 
is  much  more  clumsy  and  tedious  than  the  hot-air  or  electric- 
light  bath  ;  but  blankets  are  often  available  where  these 
latter  luxuries  are  not  to  be  had. 

Therapeutic   Indications. 

Metabolism  is  generally  stimulated  by  these  packs, 
but  if  often  repeated  they  are  very  depressing  and  enerva- 
ting, and  are  contra-indicated  if  the  patient  has  a  weak 
heart.  They  are  indicated  in  any  acute  or  chronic  tox.Tmia 
in  which  the  establishment  of  diaphoresis  is  desirable. 

In  febrile  conditions,  the  antipyretic  effect  of  the  wet 
pack  may  be  of  great  service.  Too  prolonged  application  or 
too  often  repeated  packs  will  cause  some  cardiac  depression, 
and  care  is  therefore  needed  in  this  respect.  Provided 
there  be  no  marked  cardiac  asthenia,  however,  in  some 
cases  of  hyperpyrexia  as  many  as  a  dozen  packs  may  be 
given.  In  diphtheria  this  pack  is  of  especial  use,  combined, 
of  course,  with  the  usual  antitoxin  treatment. 

Other  conditions  benefited  in  a  varying  degree  are : 
Neuralgia,  chorea,  exophthalmic  goitre,  muscular  and 
articular  rheumatism,  and  rheumatoid  arthritis. 

For  patients  who  are  unusually  nervous  in  disposition, 
and  resent  the  complete  wrapping  up  and  restriction  of 
movement,  partial  packs  may  be  employed  which,  while 
less  powerful,  are  efficient  for  soothing  and  hypnotic 
purposes. 


FOMENTATIONS     AND     POULTICES       69 

FOMENTATIONS    AND    POULTICES. 

Fomentations  and  poultices  are  simply  local  baths  to  the 
skin.  If  there  be  an  inflammatory  condition  of  skin  or 
structures  covered  by  it,  these  applications  are  a  convenient 
and  efficacious  means  of  emplo3dng  warmth  and  moisture 
in  the  treatment,  relieving  the  vessels,  increasing  the 
collateral  circulation,  and  so  relieving  the  local  circulation 
and  pain.  Thus  applied  at  the  commencement  of  inflam- 
mation, they  often  summarily  check  it,  abort  threatening 
abscesses,  and  prevent  the  formation  of  pus.  Acne 
indurata  and  herpes  labialis  may  be  much  restricted  by 
the  application  of  fomentations.  Discrimination  in  their 
employment  is  needful,  for  conditions  such  as  impetigo  con- 
tagiosa are  fostered  and  made  worse  by  such  applications. 

Again,  if  an  abscess  has  actually  formed,  the  repeated 
application  of  hot  fomentations  serves  to  "  bring  it  to  a 
head,"  as  the  vulgar  phrase  goes,  helps  the  expulsion  of 
the  pus  without  the  aid  of  the  surgeon's  knife  (though  this 
may  be  often  a  shorter  and  more  cestheticcure),  and  prevents 
the  diffusion  of  the  inflammation. 

To  be  efficacious,  a  poultice  or  fomentation  must  be  hot 
— indeed,  as  hot  as  can  be  borne — and  must  be  frequently 
changed,  at  least  every  two  hours. 

If  the  object  of  the  poultice  be  to  hasten  an  abscess 
bursting,  it  should  be  large  and  ample  ;  but  when  the 
abscess  has  burst,  a  small  poultice  or  fomentation  about 
the  size  of  the  aperture  should  be  used,  or  the  surrounding 
skin  will  become  sodden  and  irritated  from  the  repeated 
application. 

Apart  from  the  soothing  local  effect  of  fomentations 
on  inflamed  tissues,  they  have  a  similar  action  on  deep- 
seated  and  more  or  less  remote  parts  {vide  supra).  Thus 
large  hot  poultices  are  of  great  service  in  pleurisy,  pneu- 
monia, bronchitis,  pericarditis,  and  peritonitis.  In  dealing 
with  pneumonia,  caution  is  necessary  not  to  cause  additional 
respiratory  embarrassment  by  using  poultices,  especially 
for  children.  A  jacket  of  cotton-wool  or  gamgee  sprinkled 
with  turpentine  or  camphor  liniment  may  be  preferable 
in  such  cases.  The  jacket  poultice  for  children  has  fallen 
somewhat  into  desuetude. 


70  NATURAL     THERAPY 

In  peritonitis,  too,  a  poultice  should  not  be  thick  and 
heavy,  or  the  pain  may  be  made  worse.  Poultices  are 
useful  in  acute  rheumatism,  sciatica,  pleurodynia,  and 
in  various  rheumatic  pains,  and  acute  lumbago.  In  this 
last  condition  the  poultice  should  be  large,  thick  and  very 
hot  ;  it  should  be  changed  about  every  thirty  minutes, 
and  may  be  kept  up  for  three  hours  if  necessary. 

In  changing  poultices,  the  fresh  one  should  be  ready  in 
hand  while  the  cooling  one  is  removed,  so  as  to  avoid 
chilling  the  skin. 

Fomentations  are  usually  composed  of  several  thicknesses 
of  flannel  wrung  out  of  boiling  water.  They  are  less  weighty 
than  poultices,  and  less  messy  and  septic.  The  water  is 
wrung  out  of  the  flannel  by  means  of  a  wringer  made  of 
stout  huckaback  towelling  attached  to  two  sticks  (portions 
of  a  broom  handle  do  well).  The  flannel,  after  immersion 
in  boiling  water,  is  placed  in  the  wringer,  which  is  then 
firmly  twisted  round  the  flannel  until  the  water  is  squeezed 
out.  The  operator  who  manipulates  the  sticks  thus  avoids 
scalding  his  hands,  though  the  water  may  be  very  hot. 
The  heating  may  also  be  conveniently  done  by  steam, 
and  this  is  of  course  always  available  in  a  properly  equipped 
bathing  establishment.  Having  been  exposed  to  the  steam, 
the  fomentation  is  run  through  a  roller  to  remove  any 
excess  of  moisture.  Until  actually  applied  to  the  patient, 
the  fomentation  is  kept  tightly  rolled  up  in  a  towel,  by 
grasping  the  loose  ends  of  which  a  final  squeeze  can  be 
given  to  extract  moisture.  The  proper  temperature  of  the 
application  is  gauged  by  the  back  of  the  attendant's  hand. 

These  pads  are  made  in  two  sizes,  one  ii  by  22  inches, 
and  a  larger  22  inches  square.  They  are  about  half  an 
inch  thick  and  quilted.  When  applied  they  only  contain 
water  which  is  actually  absorbed  by  the  material ;  they 
should  be  covered  at  once  by  some  mackintosh  material, 
and  frequently  changed,  as  they  cool  rapidly.  When 
finally  removed,  the  skin  of  the  patient  should  be  wiped 
dry  and  covered  with  a  layer  of  flannel  or  cotton-wool,  ot 
prevent  a  chill  being  taken. 

Such  hot  fomentations  are  most  useful  in  various  colics — 
renal,  biliary,  or  gastro-intestinal. 

A  hot  pad  may  be  alternated  with  a  cold  pad  in  certain 


FOMENTATIONS     AND     POULTICES       71 

conditions,  as  follows  :  The  hot  pad  is  applied  for  five 
minutes,  and  then  a  piece  of  soft  calico  towelling  wrung 
out  of  cold  water  is  laid  over  the  part,  being  kept  on  for 
five  minutes  or  more,  when  the  hot  pad  is  once  more 
applied  to  the  surface.  Such  applications  are  useful  in 
gastric  and  gastro-intestinal  catarrh. 

Fomentations  may  also  be  medicated  in  various  ways, 
the  most  common  being  the  application  of  20  to  30  drops 
of  turpentine  oil,  constituting  "  the  turpentine  stupe." 

Poultices  are  made  of  various  substances,  bread,  linseed- 
meal,  oatmeal  or  starch.  Each  has  its  peculiar  advantages. 
The  linseed  and  oatmeal  poultices  possess  very  similar 
properties.  They  are  very  compact,  slightly  porous,  and 
retain  their  heat  and  moisture  well.  Linseed  is  somewhat 
irritating  to  certain  skins.  Bread  poultices  are  more  porous, 
cool  more  quickly,  and  dry  more  easily.  Starch  poultices 
are  ver}^  soothing,  and  retain  heat  for  a  considerable  time. 

For  making  poultices  the  water  should  be  boiling,  and  all 
the  materials  ready  to  hand.  A  sufficient  amount  of 
boiling  water  should  be  poured  into  a  heated  bowl,  and 
the  linseed  meal,  etc.,  sprinkled  in,  the  mixture  being 
quickly  stirred  until  the  mass  is  of  a  doughy  consistence. 
This  is  then  rapidly  spread  on  warm  linen,  the  edges  of 
which  are  so  turned  in  as  to  prevent  any  of  the  poultice 
escaping.  Quickness  is  essential  if  the  poultice  is  to  be  hot. 
If  the  water  be  added  to  the  meal,  a  lumpy,  uncomfortable 
mass  will  result,  not  an  evenly  consistent,  soothing  poultice. 

Bread  poultices  may  be  made  by  cutting  up  stale  bread 
into  thick  slices,  pouring  boiling  water  over  them  and 
soaking  for  a  few  minutes  ;  or  the  mixture  may  be  simmered 
in  a  saucepan  for  a  short  time.  The  bread  is  then  strained 
and  beaten  up  into  a  paste,  and  spread.  The  poultice  is 
more  porous  if  the  first  method  is  adopted. 

Starch  poultices. — A  little  cold  water  is  added  to  any 
form  of  starch,  and  a  pulp  made  ;  sufficient  boiling  ^^•ater 
is  then  added  and  the  poultice  spread. 

Bran  poultices  are  often  convenient  on  account  of  their 
lightness.  The  bran  is  placed  in  a  flannel  bag,  and  boil- 
ing water  poured  on  it. 

Mustard  Applications. — In  making  up  the  mustard  pads, 
a  large  tablespoonful  of  mustard  is  allowed  for  each  pint 


72  NATURAL     THERAPY 

of  boiling_jwater,  or  a  breakfastcupful  of  mustard  bran  to 
the  same  amount.  The  cloth  is  wrung  out  of  this  after 
a  minute  has  been  occupied  in  stirring  up  the  mixture  and 
another  minute  for  setthng.  For  less  sensitive  skins,  a 
paste  is  made  of  mustard  (and  for  this  the  mustard  bran 
is  quite  strong  enough)  and  spread  on  the  face  of  a  hot 
cloth  with  a  thin  fold  of  muslin  laid  over  it,  and  this  is 
so  expeditiously  applied  as  to  ensure  a  hot  application. 
Table  mustard  and  linseed  or  oatmeal  in  equal  proportions 
are  equivalent  in  strength  to  a  like  bulk  of  mustard  bran. 

Mustard  cloth. — A  piece  of  calico  or  towelling,  fourfold, 
wrung  lightly  out  of  hot  mustard  and  water,  is  applied  as 
hot  as  it  can  be  borne  to  the  part  indicated,  and  kept  in 
close  contact  for  twenty  minutes  at  the  most.  If  felt  too 
acutely,  it  may  be  removed  earlier.  The  effect  of  the  above 
may  be  accentuated  if  it  is  preceded  by  a  hot  fomentation 
for  five  minutes.     This  is  what  is  commonly  done  for — 

The  Liver  pack. — A  small  blanket  is  laid  across  the  couch 
or  bed,  with  w^aterproof  material  beneath.  The  patient  lies 
down  on  this,  and  a  hot  fomentation,  large  enough  to 
cover  the  whole  hypochondrium,  is  applied  for  five  minutes, 
and  then  replaced  by  a  mustard  cloth.  The  mustard 
cloth  is  usually  retained  for  fifteen  minutes.  When  patients 
are  intolerant  of  mustard,  the  hot  pad  alone  is  used. 

Mustard  plaster. — The  following  is  recommended  by 
Whitla  as  a  rapid  and  convenient  method  of  preparing  an 
ordinary  mustard  plaster. 

The  required  quantity  of  mustard  is  put  into  a  large  cup 
(about  a  tablespoonful  of  mustard  makes  a  large  sinapism) 
and  as  much  cold  water  is  poured  on  as  will  produce  a  soft 
uniform  cream,  not  quite  so  fluid  as  to  pour  out  readily. 
A  sheet  of  paper  is  procured  of  such  thickness  as  will  readily 
permit  the  fluid  part  of  the  cream  to  soak  through,  without 
becoming  too  easily  torn.  Old  newspaper  is  the  best  for 
this  purpose,  and  it  should  be  laid  upon  a  table  or 
smooth  surface,  the  mustard  cream  turned  out  of  the  cup, 
and  roughly  smeared  or  spread  over  its  centre.  The 
circumferential  or  clean  parts  of  the  paper  are  folded  over 
this,  making  the  required  shape  and  size  of  the  sinapism, 
which  is  lifted  off  the  table  and  the  surface  which  was 
undermost  applied  to  the  patient's  skin. 


FOMENTATIONS     AND     POULTICES       Td 

When  the  materials  are  at  hand,  less  than  a  minute  is 
enough  to  perform  this  little  operation.  The  plaster  can 
be  best  carried  to  the  bedside  on  a  plate.  The  mustard 
itself  does  not  actually  come  into  contact  with  the  patient's 
skin,  but  only  the  fluid  which  soaks  through  the  paper 
between  the  skin  and  the  cream. 

The  sinapism  should  be  kept  in  contact  with  the  skin 
by  means  of  a  bandage  or  pad  of  flannel.  It  is  difficult  to 
lay  down  any  absolute  time  during  which  the  plaster  should 
remain  on,  for  it  will  vary  very  much  in  individual  cases. 
After  being  apphed  for  a  few  minutes,  however,  the  edge  of 
the  plaster  should  be  raised  and  the  skin  inspected.  If  it 
remains  scarlet  for  a  few  minutes,  the  application  should  be 
removed,  but  if  the  redness  disappears,  the  appUcation 
should  be  continued.     The  twenty  minutes  above  specifled 


Fi?.  ;i7. — Ice  BaS- 

in  regard  to  mustard  cloth  are  only  approximate,  and 
represent  the  maximum.  To  push  endurance  to  the  point  of 
distress  is  a  mistake,  converting  what  should  be  a  benefit 
into  an  injury.  The  patient  must  be  told  that  when  the 
limit  of  reasonable  endurance  has  been  reached,  he  must 
do  like  Tom  Sawyer,  and  "  holler '  Nufl  !'  "  It  must  be  further 
borne  in  mind  that  mustard  applications  are  hurtful  in  the 
extreme  when  the  skin  over  the  part  concerned  is  inflamed, 
•or  indeed  shows  any  form  of  irritation.  In  such  circum- 
stances a  plain  hot  pad  without  mustard  must  suffice. 

The  Ice  Bag. — Of  this  there  are  various  forms.  That 
we  are  most  familiar  with  is  the  small  ice  bag  which  we  see 
in  the  wards  of  djvy  hospital  {Fig.  37).  It  is  a  small  bag  of 
rubber,  provided  with  a  metal  cap  and  filled  with  broken  ice. 
The  ice  helmet  is  a  modification  of  this  ;  and. there  is  also 


74  NATURAL     THERAPY 

the  well-known  Chapman's  spinal  ice  bag  {Fig.  38).  Various 
appliances  are  now  made  of  Leiter's  tubing,  whereby  ice- 
cold  water  may  be  allowed  to  flow  in  immediate  proximity 
to  any  inflamed  region,  and  the  cooling  effect  of  such  an 
appliance  is  considerably  greater  than  an  ice  bag. 

Such  appliances  are  of  great  use  in  spinal  injuries  and 
congestions,  acute  myelitis,  and  spinal  or  cerebral 
meningitis.  Opinions  differ  somewhat  as  to  the  value  of 
an  ice  bag  in  pleurisy.  Affleck  considers  it  a  most  valuable 
method  of  treatment  and  very  soothing  to  the  patient,  while 
Kellogg  considers  it  is  contra-indicated.  The  latter,  how- 
ever, speaks  highly  of  the  ice  collar  in  diphtheria,  when 
applied  for  fifteen  or  twenty  minutes  in  place  of  a 
fomentation.  The  effect  is  to  decrease  the  hyperjemia  of 
the  affected  area  reflexly,  and  also  by  contraction  of  the 
carotids. 


Fig.   38. — Chapman's  Spinal  Ice  Bag- 

Chapman  made  a  variety  of  claims  for  his  spinal  ice  bag 
which  have  been  more  or  less  substantiated.  He  found 
it  had  a  sedative  influence  on  the  spinal  cord,  but  alsQ 
that  he  could  to  some  extent  increase  or  diminish  the  cir- 
culation in  any  part  of  the  trunk,  by  varying  the  part  of  the 
spine  to  which  he  applied  the  bag.  If  he  wished  to  influence 
the  head,  he  applied  the  bag  to  the  neck  and  shoulders  ; 
if  the  chest  and  arms,  he  applied  it  to  the  upper  part  of  the 
back  ;  and  to  the  lumbar  region  for  the  pelvis  and  legs. 
In  this  way  he  could  influence  the  occurrence  of  menstruation,. 
and  he  states  that  after  a  brief  application  to  the  lower 
dorsal  region  he  has  seen  the  feet  become  very  rapidly 
warm.  He  also  found  it  useful  in  sea-sickness  and  the 
vomiting  of  pregnancy.  By  filling  the  bag  with  hot 
water,  on  the  other  hand,  he  could  induce  contraction  in  the 
vessels  which  were  dilated  by  the  application  of  cold,  and 
was  in  this  manner  able  to  arrest  menorrhagia,  epistaxis> 
and  other  haemorrhages. 


75 


CHAPTER    V. 

THE    NAUHEIM    BATHS. 

nr  HESE  baths  have  been  known  for  about  half  a  century, 
-*-  but  more  recently  Beneke,  of  Marburg,  advised  their 
use  in  the  treatment  of  various  forms  of  cardiac  disability. 
They  are  composed  of  water  charged  either  naturally  or 
artificially,  in  varying  degree,  with  carbonic  acid  gas,  and 
containing  small  quantities  of  saline  matter,  such  as  chloride 
and  sulphate  of  soda.  The  specific  gravity  averages  about 
1005.  At  Nauheim  the  springs  used  for  this  purpose 
contain  chloride  of  sodium,  chloride  of  calcium,  and  a 
varying  amount  of  CO,.  The  "  Neuer  Sprudel  "  contains 
only  approximately  i  cc.  per  litre  of  the  gas,  while  the 
"  Grosser  Sprudel "  contains  over  3  cc.  per  litre.  The 
course  of  baths  is  always  commenced  with  the  springs  weak 
in  carbonic  acid  gas  ;  indeed,  at  the  start  the  waters  are 
allowed  to  give  off  the  whole  of  their  gas,  while  some 
"  mutter-lauge,"  rich  in  calcium  chloride  and  bromine, 
is  added  to  them.  Later  a  spring,  the  water  of 
which  is  richer  in  CO.,,  is  used,  and  this  is  gradually 
increased  until  strong  carbonaceous  waters,  flowing  con- 
tinuously in  and  out  of  the  bath,  are  employed  (Sprudel 
Strombad). 

The  action  varies  with  the  temperature  and  degree  of 
carbonation  of  the  water  employed.  Small  bubbles  of 
the  gas  adhere  to  the  skin  of  the  patient,  which  is  powerfully 
stimulated  thereby,  and  becomes  reddened.  There  is  a 
sensation  of  heat  and  prickling  and  some  degree  of  hyper- 
aesthesia.  The  cutaneous  vessels,  "  peripheral  heart,"' 
become  surcharged  with  blood  to  the  relief  of  chronically 
overloaded  and  halting  ventricles. 

One  of  the  advantages  of  this  bath  is  that  it  can  be  given 
practically    anywhere    by    means    of    artificially    prepared 


76  NATURAL     THERAPY 

water.  There  are  several  good  preparations  on  the  market 
for  this  purpose — among  the  best  known  being  Sandow's,* 
the  "  Croyden,"t  recommended  by  Bezly  Thorne,  and  the 
"  Zana  "  preparations  of  Zuckert  (consisting  of  bicarbonate 
of  soda  and  formic  acid  in  solution). 

The  Sandow  preparations  are  put  up  in  boxes  containing 
four  packets  of  bicarbonate  of  soda,  and  eight  tablets  of 
acid  sulphate  of  soda.  Eight  parts  of  the  former  exactly 
neutralize  twelve  parts  of  the  latter,  but  the  alkali  should 
always  be  in  excess.  Thirty-two  ounces  bicarbonate  of  soda, 
with  twenty-two  ounces  of  acid  sulphate,  will  make  a  good 
bath  of  forty  gallons,  and  will  generate  about  250  cc.  of 
gas  per  litre  of  water.  A  whole  packet  of  Sandow  should 
be  added  to  forty  gallons  of  water  containing  about  10  lb. 
of  chloride  of  sodium  and  10  oz.  of  chloride  of  calcium,  to 
make  a  strong  bath. 

At  the  commencement  of  treatment,  however,  where  no 
effervescence  is  desired,  the  bath  can  be  made  up  with  4  lb. 
of  chloride  of  sodium,  and  6  oz.  of  chloride  of  calcium. 
Later,  half  a  box  of  Sandow  may  be  added  to  this,  and 
later  again  a  whole  box  used  with  the  stronger  brine.  The 
material  for  the  brine  can  be  easily  obtained  from  the  Salt 
Union  at  Nantwich. 

The  temperature  of  the  water  varies  from  36°  C.  to  30°  C, 
beginning  at  the  higher  temperature  and  being  gradually 
lowered. 

Carbonic  acid  gas  is  best  obtained  in  large  institutions 
and  hospitals  by  means  of  the  special  apparatus  of  the 
Fischer-Kief er  Co.,  of  Zurich  {Plate  XVII).  This  produces 
a  more  even  carbonation  of  the  water  than  is  possible 
with  powders,  but  is  of  course  too  elaborate  and  expensive 
a  method  for  private  houses.  An  enterprising  medical 
man  known  to  the  writer  obtained  his  C0„  by  means 
of  the  plant  of  an  aerated  water  manufacturer  whose 
premises  adjoined  his  own  ! 

Technique  of  the  Bath. — The  patient  should  recline  at  an 
angle  of  about  45°,  with  his  entire  body  up  to  the  head  and 


*  Buchner,  149,  Houndsditch,  London,  E.C. 

■f  Croyden  &  Co.,   55,  Wigmore  Street,  W. 

j  The  Hygienic  Co.,  Southwark  Bridge  Road,  S.E. 


PLATE     XVII. 


The    FisciiER-KiEFER   C0>    Generator    for    Nauheim    Bati 


THE     NAUHEIM     BATHS 


77 


neck  immersed  in  water  {Fig.  39).  The  bathroom  should 
be  well  ventilated,  and  the  patient  should  breathe  regularly, 
abstaining  from  conversation. 

Some  sense  of  oppression  is  commonly  felt  at  first,  but 
will  soon  pass  off  if  the  patient  takes  two  or  three  deep 
inspirations,  "  which  facilitate  the  passage  through  the 
pulmonary  circuit  of  the  blood  which  is  being  driven  through 
the  right  heart  from  the  splanchnic  and  other  venous 
reservoirs."  The  patient  must  leave  the  bath  at  the  exact 
time  prescribed,  and  be  at  once  enveloped  in  a  warm 
bath     towel,     and     carefully    rubbed     dry    by    the     bath 


\.:fl^ : 

tfp" 

m 

HESS 

~  -  >   -       4          %■          4           f 

^m 

^H^BH^^HHr       ^    - 

■r    1       U 

' 

\m 

^  -1 . 1  •-.'' 

>h 

'VfeiHk^,.,.,^  .^ 

_  % 

• 

* 

^*x..  , 

,lj^ 

1^^^*        ^ 

♦- 

■—•♦-- 

"■■■■— \^ 

Am 

^ESS^m^^^ 

¥ 

^^H^^KS:  ".'.;- 

■^^l^mtmm^ 

■B 

Fig.  39. — I^atient  iii   the  Nauheim  Bath. 


attendant.  He  should  then  lie  down  on  a  couch  in  an 
adjoining  apartment,  and  rest  for  at  least  an  hour  before 
dressing. 

The  duration  of  the  bath  and  the  strength  of  the  con- 
stituents must  vary  with  each  individual  and  the  stage 
of  treatment.  In  many  cases,  careful  observation  on  the 
part  of  the  physician  himself  is  desirable. 

The  baths  are  usually  taken  in  a  course  of  twelve,  and 
rarely  should  more  than  three  be  taken  in  each  week. 
On  the  days  on  which  there  is  no  bath  the  patient  is  put 
through  the  Schott-Nauheim  Exercises. 


78 


NATURAL  THERAPY 


THE  EFFECT  OF  THE  BATHS  AND  EXERCISES 
ON  THE  CIRCULATORY  ORGANS. 

In  all  conditions  dependent  on  arteriosclerotic  changes 
and  atheroma,  such  as  commencing  aneurysm,  congestion  ol 
the  abdominal  viscera,  and  imperfect  emptying  of  the 
heart,  if  the  tissue  changes  have  not  passed  beyond  the 
reach  of  repair,  frequently  relief  and  sometimes  cure  may  be 
afforded  by  the  suitable  use  of  the  Schott-Nauheim  system. 
It  has  indeed  been  proved  beyond  reasonable  doubt  that 
early  conditions  of  arterial  degeneration  can  be  greatly 
ameliorated  by  this  method  of  treatment,  and  to  a  much 
greater  degree  than  can  be  effected  by  any  known  drug 
■or  combination  of  drugs.  By  this  treatment  the  heart  is 
stimulated  to  more  complete  systole,  and  residual  blood  is 

expelled,  while  the  peripheral 
resistance  in  the  circulation 
is  diminished.  Benefit  is 
always  derived  where  it  is  to 
the  advantage  of  the  patient 
to  restore  healthy  substance 
and  proportionate  working 
capacity  to  the  myocardium. 
The  beneficial  action  is 
only  limited  by  the  degree  of 
obstruction  in  the  nutrient 
arteries  and  the  degeneration 
of.  their  coats.  If  these 
changes  are  far  advanced, 
then  increased  force  in  the 
cardiac  systole  will  only 
accelerate  the  degeneration 
and  hasten  the  end.  While  reparative  processes  take  place 
with  readiness  in  the  coronaries  and  the  myocardium, 
organic  changes  in  the  valves  from  chronic  endocarditis 
are  beyond  the  range  of  any  line  of  treatment. 

It  may  be  said  that  in  valvular  lesions  the  well-being  and 
duration  of  life  of  the  patient  depend  on  the  measure  of 
■compensatory  hypertrophy  and  the  absence  of  myocardial 
■degeneration.  This  is  probably  more  true  of  aortic 
regurgitation  than  of  any  other  lesion. 


Fig.  40. — Diagram  of  Cardiac  Dullness  as 
affected  by  Nauheim  Baths. 


THE     XAUHEIM     BATHS 


79 


In  short,  the  Xauheim  treatment  is  of  the  highest  efficacy 
in  estabhshing  compensation  in  valvular  disease  of  what- 
ever nature,  and  restoring  the  myocardium  to  a  healthy 
condition. 

In  cases  of  cardiac  dilatation,  the  diminution  of  the 
area  of  cardiac  dullness  is  very  striking.  Indeed,  Kellogg 
states  that  after  one  bath  he  has  found  the  superficial 
dullness  one  inch  less  in  its  transverse  diameter  in  cases 
of  marked  dilatation  and  loss  of  compensation. 

It  is  well  to  keep  a  record  of  such  cases  by  a  simple 
diagram,  such  as  Fig.  40. 

The  Schott  brothers  have  also  emphasized  the  value  of 
the  baths  in  this  respect,  having  found  a  progressive  and 


Fig:.  41. — Pulse- Tracing :     (n)  Before,   (b)   After  a  Four-week  course  of  Xauheim  Baths. 

appreciable  reduction  in  the  area  of  cardiac  dullness  after 
a  short  course  of  these  baths  [Fig.  41). 

THE    SCHOTT-NAUHEIM    EXERCISES. 

Technique. — The  body  should  be  held  upright  and  joints 
kept  straight.  The  resistance  applied  should  not  be 
sufficient  to  cause  any  shortness  of  breath  or  tremor  in  the 
patient's  limbs. 

The  resistance  may  be  applied  b\'  the  patient  himself 
putting  into   action   the  opposing  muscles  to  those  which 


80  NATURAL     THERAPY 

effect  the  movement,  or  by  an  attendant,  commonly  called 
"  the  operator."  Each  movement  should  be  performed 
slowly  and  evenly,  at  a  uniform  rate,  and  not  repeated 
twice  in  the  same  limb  or  group  of  muscles.  The  patient's 
breathing  should  not  be  accelerated,  and  any  duskiness 
or  pallor  of  the  cheeks,  yawning,  dilatation  of  the  alae 
nasi,  or  drawing  in  of  the  corners  of  the  mouth,  must  be 
taken  as  a  signal  for  the  immediate  suspension  of  the 
movements.  In  order  to  prevent  the  patient  closing  the 
glottis  and  holding  his  breath,  he  should  be  told  to  keep 
counting  in  a  whisper. 

The  Exercises. 

1.  The  arms  are  to  be  raised  slowly  outwards  from  the  side  until 

they  are  on  a  level  with  the  shoulder.  After  a  pause  they 
should  be  slowly  lowered. 

2.  The  body  should  be  inclined  sideways   as   much  as  possible 

towards  the  right,  and  then  to  the  left. 

3.  One  leg  should  be  extended  as  far  as  possible  sideways  from 

the  body,  the  patient  steadying  himself  by  holding  on  to  a 
chair.  The  leg  is  then  dropped  back.  The  same  movements 
are  repeated  by  the  other  leg. 

4.  The  arms  are  raised  in  front  of  the  body  to  a  level  with  the 

shoulder,  and  then  put  down. 

5.  The  hands  are  rested  on  the  hips,  and  the  body  is  bent  forwards 

as  far  as  possible,  and  then  raised  to  the  upright  position. 

6.  One  leg  is  raised  with  the  knee  straight,  forwards  as  far  as 

possible,  then  brought  back.  This  movement  is  repeated 
with  the  other  leg. 

7.  With  the  hands  on  the  hips,  the  body  is  twisted  round  as  far 

as  possible  to  the  right,  and  then  again  to  the  left. 

8.  With  the  hands  resting  on  a  chair,   and  the  back  stiff  and 

straight,  each  leg  is  raised  as  far  as  possible  backwards,  first 
one  and  then  the  other. 

9.  The  arms  are  extended  and  the  fists  supinated.     The  arms  are 

then  extended  outwards,  next  inwards,  at  the  height  of  the 
body. 

10.  Each  knee  is  first  raised  as  far  as  possible  to  the  body,  and 

then  the  leg  extended. 

11.  This    movement   is    the    same   as    No.    9,   but    with   the    fists 

pronated. 

12.  Each  leg  is  bent  backwards  from  the  knee,  and  then  straigth- 

encd. 

13.  Each  arm  is  bent  and  straightened  from  the  elbow. 

14.  The  arms  are  brought  from  the  sides  forwards  and  upwards, 

then  downwards  and  back  as  far  as  they  will  go,  the  elbows 
and  the  hands  being  straight. 


THE     NAUHEIM     BATHS  81 

15.  The  arms  are  put  at  a  level  with  the  shoulder,  and  then  bent 

from  the  elbows  inwards  and  again  extended. 

16.  With  the  arms  in  front  at  the  level  of  the  shoulder,  and  the 

hands  stretched,  the  arms  are  opened  out  sideways  and  then 
brought  together. 

17.  The  arms  are  bent  from  the  elbow  outwards  and  extended. 

Bezly  Thorne  enumerates  the  following  conditions  as 
suitable  for  Nauheim  treatment  : — 

Palpitation,  with  and  without  hyperpiesis. 

The  strained  heart  of  athletes. 

Cardiac  dilatation,  with  "  air-hunger  "  symptoms. 

Petit  mal  (of  the  cardiac  type). 

Cerebral  neurasthenia. 

Tachycardia  and  bradycardia,  exophthalmic  goitre. 

Cheyne-Stokes  breathing  dependent  on  arteriosclerosis. 

Summary  of  Action. — The  primary  effect  in  most  cases 
is  to  reduce  the  pulse-rate  by  4  to  6  beats  per  minute, 
while  the  pulsations  are  rendered  more  vigorous  owing  to 
the  improved  coronary  flow.  The  cutaneous  vessels  become 
dilated  ai;d  hyperaemic,  while  the  internal  vessels  are  con- 
tracted. The  output  of  urine  and  CO^  are  both  increased. 
There  is  a  more  complete  contraction  of  the  right 
ventricle,  and  increased  vascular  tonus  throughout  the 
whole  circulatory  system.  There  is  a  marked  improvement 
in  the  general  health  and  nutrition  of  the  patient. 

The  opinions  of  some  of  the  leaders  in  medicine  on  the 
subject  of  these  baths  are  of  interest.  Sir  Douglas  Powell 
says  :  "  The  employment  of  carefully  graduated  and 
observed  exercises  of  Schott  may  be  regarded  as  especially 
adapted  for  the  treatment  of  the  flabby,  irritable, 
'  stuff}^ '  hearts — cases  of  fatty  infiltration  and  impaired 
metabolism — which  are  met  with  in  people  of  venous 
plethora. 

"  In  cases  of  chlorosis  with  dilated  heart,  after  a  pre- 
liminary week  or  two  of  complete  rest,  the  Schott  treatment 
is  of  value  when  combined  with  a  chalybeate  and  a  dry 
bracing  climate. 

"  In  the  first  commencing  failure  of  heart  in  chronic 
valve  disease,  the  treatment  may  be  employed,  combined 
with  a  more  or  less  complete  cessation  from  other  forms 


82  NATURAL    THERAPY 

of   exercises,    and   similarly   after   such    cases   have   been 
restored  up  to  a  certain  point  by  digitalis  treatment. 

"  Further,  certain  cases  from  the  symptoms  of  which  we 
recognize  the  presence  of  atheromatous  changes  in  the 
coronary  vessels,  the  treatment  may  be  cautiously  tried 
in  combination  with  much  rest.  The  treatment  is  un- 
doubtedly an  aid  to  our  therapeutics." 

Broadbent's  opinion  was  as  follows  :  "In  cases  of  cardiac 
dilatation  from  loss  of  tone  of  the  heart  after  influenza  or 
some  depressing  disease,  it  may  be  of  great  service,  and  effect 
a  cure  where  drugs  and  other  treatment  have  failed. 

"  In  many  cases  of  functional  and  neurotic  heart  disease, 
which  are  commonly  difftcult  to  deal  with,  it  may  also  give 
satisfactory  results. 

"  In  valvular  disease,  it  is  of  course  unnecessary  when 
compensation  has  been  established  and  no  symptoms  are 
present  ;  when  compensation  has  completely  broken  down 
it  is  not  advisable  to  rest  in  bed,  and  suitable  treatment 
by  other  means  may  be  more  efficacious. 

"  In  cases  of  mitral  disease,  more  especially  mitral  stenosis, 
when  compensation  is  just  maintained  with  difficulty,  when 
the  degree  of  stenosis  is  such  that  increased  contractile 
power  of  the  right  ventricle  induced  by  digitalis  would  be 
useless  or  harmful,  it  may  be  of  great  service.  In  aortic 
disease  it  is  not  advisable,  owing  to  the  risks  of  syncopal 
attacks,  though  when  compensation  is  breaking  down  it  may 
sometimes  yield  good  results.  In  adherent  pericardium, 
with  threatened  compensatory  failure,  it  may  be  of  service." 

Professor  Lindsay  says  :  "I  must  confess  I  read  with 
some  incredulity  the  reports  of  rapid  diminution  of  cardiac 
dilatation  under  this  treatment,  and  I  entertain  no  doubt  that 
increased  expansion  of  the  lungs  is  the  main  factor  in  the 
alteration  of  the  percussion  area  of  the  heart  which  has  been 
described."  While  admitting  slight  experience  of  the 
method,  Lindsay  considers  "  the  advantages  consist  in 
the  methods  employed  being  thoroughly  systematized, 
controlled,  and  regulated." 

Strumpell  writes  :  "  The  employment  of  baths  in  heart 
disease  deserves  special  consideration.  Numerous  ex- 
periences go  to  prove  that  they  are  well  borne,  not  only  by 
patients  with  heart  disease,  but  that  they  exercise  peculiar 


THE     XAUHEIM     BATHS  83 

and  beneficial  and  invigorating  influence  on    the  action  of 
the  heart." 

In  view  of  the  above  there  seems  to  be  no  room  for 
scepticism  or  reasonable  doubt  that  the  use  of  Nauheim 
baths  and  exercises  in  many  cardiac  and  associated 
conditions  is  in  the  clearest  manner  indicated. 

Coxtra-Indicatioxs. 

In  cases  with  albuminuria  due  to  chronic  Bright's  disease 
(large  white  kidney),  it  is  better  not  to  prescribe  these 
baths. 

They  are  also  unsuitable  when  the  patient  is  suffering 
from  eczema,  from  angina  pectoris  associated  with  cardiac 
asthma,  or  from  marked  oedema  or  peripheral  neuritis. 


84 


CHAPTER     VI. 

PEAT,     FANGO,     AND     OTHER 
MEDICATED     BATHS. 

npHESE  are  semi-solid  baths  of  varying  density  and 
-*-  temperature  ;  with  them  may  be  included  the  "  hot 
sand  "  bath  and  the  hot  seaweed  bath.  They  are  used 
chiefly  for  their  thermic  and  mechanical  effects,  but  also 
to  some  extent  for  their  chemical  action. 

Peat  is  a  form  of  turf  soil  consisting  of  dried  and  de- 
composed vegetable  matter  which  has  undergone  certain 
chemical  changes  induced  by  constant  intimate  contact  with 
mineral  matter  percolating  through  it  for  thousands  of  years. 
Apart  from  dried  grass  fibre,  root  and  bituminous  substances, 
it  contains  silica,  phosphate  and  sulphate  of  iron,  sodium 
chloride,  and  sulphuretted  hydrogen,  as  well  as  sulphuric  and 
carbonic  acid.  After  undergoing  complete  disintegration 
by  exposure  to  the  weather,  the  peat — by  admixture  with 
hot  water — is  made  into  a  soft  mush  or  mud,  of  the  con- 
sistence of  fine  porridge,  practically  free  from  grit.  The 
amount  and  nature  of  the  chemical  salts  present  in  the 
peat  from  any  district  will  of  course  depend  on  the  nature 
of  the  springs  in  the  district  and  the  amount  and  quality 
of  saline  matter  they  contain.  Sulphates,  carbonates,  and 
chlorides  can  be  added  to  the  hot  water  prior  to  mixing  it 
with  the  peat. 

The  peat  baths  at  Marienbad  are  ferruginous  in  character, 
and  those  at  Driburg  sulphurous. 

Action. — A  peat  bath  exerts  a  considerable  mechanical 
effect,  resembling  that  of  massage,  through  compression  and 
friction.  The  capacity  of  peat  for  retaining  heat  is  much 
greater  than  water,  and  these  baths  can  be  employed  at 
much  higher  temperatures  than  water  baths.  The  motor 
and  sensory  cutaneous  nerves  are  markedly  stimulated. 

Fango  Di  Battaglia. — Fango  is  the  volcanic  mineral 
deposit  from  the  hot  springs  of  Battaglia,  near  Padua.     It 


PEAT    AND     FANGO     BATHS 


85 


has  been  used  for  centuries  by  the  Itahans  for  the  rehef  and 
cure  of  painful  affections,  such  as  sciatica,  himbago,  gout, 
rheumatism,  etc. 

Its  value  being  recognized  by  visitors  to  Battaglia,  it  was 
imported  to  some  of  the  Continental  bathing  places,  and  its 
properties  were  tested  under  skilled  and  scientific  observa- 
tion. The  results  were  so  satisfactory  that  it  has  been 
gradually  adopted  at  the  principal  health  resorts,  which  now 
owe  a  great  part  of  their  success  to  the  results  of  fango 
treatment.  At  Baden-Baden,  Kissingen,  etc,  its  use  has 
greatly  increased.  The  use  of  fango  dates  from  very 
early  times.  Under  the  Roman  Empire  the  applications 
of  this  material  at  the  Eugean  Thermse  were  noted  for 
their  excellent  effects.* 

In  appearance  fango  is  a  soft  greyish-brown  plastic 
substance  of  the  consistence  of  butter,  and  equally  soft  to 
the  touch.  It  is  odourless,  and,  after  the  appHcation  is 
finished,  can  be  quickly  and  completely  removed  from  the 
skin  by  means  of  a  douche  of  warm  water,  leaving  the  skin 
surface  absolutely  clean. 

Chemical  Analysis. — Fango  is  rich  in  iron,  argillaceous 
earth,  magnesia,  lime,  and  alkalies,  united  with  phosphoric 
and  sulphuric  acids. 

In  100  parts. 

Combustible  and  volatile  matter  ...  ...  iO'qS 

Soluble  in  Acids        ...  ...  ...  ...         41 'S^ 

Insoluble 


The  portion  soluble  in  acids  is  composed  of 

Carbonic  Acid 
Sulphuric  Acid 
Silica 

Oxide  of  Iron 
Phosphates ... 
Carbonate  of  Lime 
Magnesia 
Potassium   1 
Sodium        ) 


as  Sulphates 


58-64 


9-34 
6-65 
7-86 
9-81 
1-83 
6-05 
1-40 

0-94 


In  addition  there  are  traces  of  the  rarer  minerals,  such  as 
thorium,  helium,  and  radium. 


*   Fango  baths  were  first   introduced  into   this  country  at   the  bath- 
ing establishment  connected  with  the  Roj-al  Hotel,  Matlock  Bath. 


86  NATURAL    THERAPY 

In  order  to  bring  the  fango  to  a  proper  temperature  for 
application  to  the  body,  it  is  heated  in  a  large  water-j  acketed 
or  steam-jacketed  pan.  The  temperature  at  which  it  is 
applied  is  a  most  important  point,  and  it  is  essential  that 
the  heat  should  be  easily  controlled.  The  apparatus  in 
general  use  is  a  large  tinned  copper  pan  with  a  lid.  The  pan 
is  surrounded  by  a  water  chamber,  and  the  latter  is  heated 
by  a  number  of  large  gas  Bunsen  burners.  The  heating 
takes  place  but  slowly,  but  the  cooling  is  equally  slow,  and 
when  once  a  large  mass  of  fango  is  raised  to  proper 
temperature,  it  takes  some  hours  to  cool.  The  application 
is,  indeed,  a  large  sterihzed  mineral  poultice  enveloping 
the  affected  part  {Plate  XVIII). 

Temperature  and  Duration  of  Application. — It  was  at 
first  thought  important  to  obtain  as  high  a  temperature 
as  possible  in  the  fango  treatment,  but  this  was  an  erro- 
neous idea.  The  following  rules  should  be  observed  in  a 
general  way  : — 

To  begin  with,  a  low  temperature  should  be  used,  and 
gradually  raised  by  a  degree  or  so  at  a  time.  A  low 
temperature  for  fango  is  45°  C  ;  the  highest  temperature 
endurable  is  56°-58°  C,  at  which  signs  of  burning  show 
themselves.  Generally  speaking  a  temperature  of  54°-55°  C. 
is  sufficient. 

The  higher  temperatures  are  only  useful  in  the  treatment 
of  deep-lying  abdominal  or  thoracic  viscera.  For  all  kinds 
of  neuralgias,  low  temperatures  (45°  C.)  are  advisable. 
With  old  or  weak  patients,  the  temperature  should  never 
exceed  49°  C,  and  the  packs  be  given  only  on  alternate 
days.  Packing  should  not  take  longer  than  thirty-five  to 
forty-five  minutes. 

For  washing  off  the  fango,  a  warm  douche  or  spray  is 
recommended.  General  baths  are  not  desirable.  Neuras- 
thenics, and  those  suffering  from  some  other  nervous  com- 
plaints, usually  require  a  cold  douche  after  the  warm  one, 
followed  by  a  rubbing  down. 

Reaction. — The  patient  should  be  warned  at  the  com- 
mencement that  a  reaction  takes  place  (and  sometimes  even  ' 
repeats  itself).     During  the  time  of  this  reaction,   which 
usually  appears  after  a  few  applications,  the  affected  part  is 
frequently  much  more  painful  and  sensitive.     After  a  few 


PLATE     XVIII. 
FANGO     TREATMENT. 


F/-.  A. — Application    of   the    Faxgo. 


II".    B. I'ACKED-UF. 


PEAT  AND  FANGO  BATHS     87 

more  applications  the  pain  subsides  again,  and  usually  a 
steady  improvement  sets  in. 

Fango  treatment  can  be  employed  from  infancy  to  old 
age,  and  with  every  constitution,  even  with  such  as  suffer 
from  severe  heart  complaints.  Cases  with  high  fever, 
advanced  phthisis,  or  women  who  are  enceinte,  should  not 
be  treated  with  fango. 

A  very  important  point  in  fango  as  well  as  in  every 
other  thermal  treatment,  is  that  the  physician  should 
keep  a  sharp  eye  on  the  patient,  especially  at  the  beginning, 
and  see  him  after  every  third  and  fifth  packing  ;  and  also 
that  he  adapts  his  prescriptions  to  the  individual  case. 

The  Action  of  Fango. — The  action  of  fango  must  be 
considered  in  a  threefold  aspect  :  the  chemical,  the 
mechanical,  and  the  thermal.  The  chemical  effect  has 
not  yet  been  made  sufficiently  clear,  and  there  are  great 
differences  of  opinion  concerning  it.  The  mechanical  effect 
consists  in  the  pressure  exercised  by  the  layers  of  fango, 
which  act  like  a  gentle  massage.  The  cause  of  the  thermal 
action  is  of  course  to  be  found  in  the  high  temperature  to 
which  fango  has  to  be  brought  ;  a  balancing  of  the  heat  of 
the  body  and  the  heat  of  the  fango  takes  place,  and  the  body 
remains  always  under  the  same  warming  layer. 

The  physiological  effect  of  fango  applications  on  the  blood- 
pressure,  the  distribution  of  the  blood,  and  on  the  heart 
may  be  shortly  expressed  as  follows  :  According  to  many 
observations  the  frequency  of  the  pulse  is  diminished  at  the 
beginning  of  the  application,  becomes  greater  after  about  ten 
minutes  (an  increase  of  6  to  8  per  minute),  then  diminishes 
again  by  2  to  3  per  minute,  and  after  this  remains  stationary 
until  the  end  of  the  application.  The  application  is 
immediately  followed  by  an  increased  tonus  of  the  blood- 
vessels, this  being  the  consequence  of  the  irritation  of  the 
vaso-constrictors ;  the  skin  becomes  pale  ;  the  blood-pressure 
is  heightened  for  a  short  time  ;  then  a  hyperasmia  of  the 
cuticle  takes  place  through  paratysis  of  the  constrictors, 
and  with  it  a  reduction  of  the  heart  action  in  consequence 
of  diminished  resistance.  According  to  Baelz  this  paralysis 
is  not  annulled  by  cold,  and  patients  could  leave  the 
bathing-house  undressed,  even  in  winter,  without  catching 
cold. 


88  NATURAL    THERAPY 

The  reflex  action  of  tlie  sensory  and  temperature  nerves 
on  the  heart  is  kept  up,  a  douching  with  cold  water  is  at 
once  followed  by  a  decrease  of  the  number  of  pulse  strokes, 
and  by  a  strengthening  of  the  heart  action,  without  diminu- 
tion of  the  redness  of  the  skin.  Baelz  noticed  also  that 
the  blood  of  anaemic  patients  is  greatly  improved  after 
a  fango  application.  The  temperature  of  the  body  is 
heightened  during  the  application,  particularly  during  the 
first  quarter  of  an  hour  (i°  to  1-5°  C.  or  more).  According 
to  Maggiora  and  Levy,  this  is  not  so  much  the  result  of 
a  lessening  of  the  radiation  of  heat  as  of  a  direct  heating 
of  the  blood  through  the  far  hotter  fango.  In  the  beginning 
of  the  application  a  diminished  frequency  of  respiration  is 
observable,  which  increases  after  about  ten  minutes  by 
four  or  five  breaths,  without  being  followed  later  on  by 
oppression  or  deeper  breathing, 

A  fango  application  does  not  relax  the  muscles,  and  very 
little  fatigue  is  subsequently  felt.  An  increased  secretion 
of  nitrogen  can  be  proved  either  in  the  perspiration  or  in 
the  urine.  Gout  especially  produces  an  increased  secretion 
of  uric  acid.  The  action  of  fango  on  the  nerves  differs 
according  to  the  temperature  employed  :  it  either  promotes, 
hinders,  or  altogether  stops  their  action.  The  physiological 
facts  justify  its  employment  in  the  following  ways  :  Fango 
is,  First,  the  best  cataplasm  known.  Its  density,  its  even 
consistency,  its  low  specific  heat,  the  fact  of  its  being  a 
non-conductor  of  heat,  and  the  mild  counter-irritation  it 
produces  on  the  cuticle  permit  it  to  act  for  a  long  time  on  a 
considerable  area  of  the  body,  even  when  brought  to  a  high 
temperature,  without  substantially  disturbing  either  the 
pulse,  the  blood-pressure,  or  the  heart  action,  without 
producing  congestions  and  oppressions,  or  leaving  behind 
(like  other  kinds  of  baths)  a  great  feeling  of  relaxation  and 
fatigue.     Secondly,  fango  is  an  excellent  diaphoretic. 

Through  its  action  on  the  distribution  of  the  blood  in 
the  organism,  fango  has  a  diverting  effect,  while  in  the 
cuticle  it  produces  hypera;mia.  In  both  cases  the  effect 
is  an  intensive,  passive  one,  with  diminished  tonus  of  the 
vascular  system,  of  long-continued  duration.  We  are 
therefore  able  not  only  to  effect  a  momentary  lessening  of 
congestion  in  cases  of  hypersemia  of  the  inner  organs  as  well 


PEAT  AND  FANGO  BATHS      89 

as  of  the  mucous  membranes  of  the  respiratory  and  intestinal 
tracts,  and  in  hypersemia  of  the  brain  and  its  membranes, 
but  the  effect  endures,  and  by  a  methodical  continuation 
■of  the  treatment  the  vessels  of  the  affected  parts  will  by 
degrees  resume  their  normal  tonicity  and  fullness. 

On  the  other  hand,  fango  applications  produce  an  increased 
supply  of  blood  of  a  higher  temperature,  with  consequent 
perspiration,  in  rheumatic  affections  of  the  joints  and  of  the 
nerves,  and  in  this  manner  they  promote  the  resorption  of 
all  sorts  of  effusion,  and  particularly  of  perimetritic  exu- 
date as  well  as  gouty  deposits,  etc. 

Combined  with  a  suitable  diet,  fango  treatment  is  of 
great  advantage  in  affections  of  the  intestinal '  tract, 
especially  in  chronic  catarrh  of  the  bowels. 

Rheumatism,  Subacute  or  Chronic,  will  always  be  one 
■of  the  chief  indications  for  fango  treatment.  The  results 
obtained  are  completely  successful.  Cases  usually  come 
under  treatment  after  having  suffered  some  time.  The 
reaction  may  take  two  or  three  days,  and  according  to  its 
intensity  the  doctor  will  continue  or  discontinue  the  pack 
for  two  or  three  days,  or  else  lower  the  temperature.  After 
a  thorough  improvement  has  taken  place  it  is  advisable  to 
give  five  to  ten  more  packs,  so  as  to  prevent  a  relapse. 

Chronic  Articular  Rheumatism  (in  all  its  stages,  up  to 
;arthritis  deformans). — The  greatest  field  for  fango  treatment 
•is  offered  by  this  complaint.  The  packs  are  first  applied  at 
115°  F.,  the  temperature  being  increased  by  about  one 
■degree  daily,  till  128°  to  130°  F.  is  reached.  In  this  com- 
plaint the  temperature  should  be  increased  in  spite  of  the 
reaction,  which  takes  place  usually  after  the  second  until 
the  sixth  packing,  and  lasts  from  two  to  five  days.  Only 
with  a  very  acute  reaction  should  the  temperature  be 
lowered.  In  the  general  course  of  treatment,  reactions  often 
"take  place  later  on.  These  are  usually  rather  intense,  but 
■do  not  last  more  than  a  day  or  so,  and  generally  announce 
a  new  amelioration. 

If  the  joint  becomes  swollen  by  fluid  effusion,  skilful 
massage  may  be  required.  Often  rather  large  synovial 
effusions,  occurring  during  the  first  few  packs,  go  down 
after  a  little  time  by  merely  continuing  the  packs.  As  a 
rule,  use  massage  in  cases  where  it  appears  to  be  called 


90  NATURAL    THERAPY 

for  (e.g.,  in  contractions  and  thick  old  effusions)  only  after 
the  reaction,  and  call  the  attention  of  the  patient  to  the 
fact  that  an  increase  of  pain  may  at  first  result  from  the 
massage. 

Rheumatoid  Arthritis.  —  Massage  is  generally  given 
from  the  beginning,  except  where  the  joints  are  very  painful. 
An  improvement  almost  invariably  takes  place,  the  intense 
pains  are  alleviated,  and  for  a  time  they  may  disappear 
entirely.  The  treatment  should  be  of  longer  duration,  and. 
repeated  at  intervals  of  six  months  at  least. 

Muscular  Rheumatism. — The  fango  is  applied  first  at 
47°  C,  and  gradually  raised  as  high  as  bearable.  Reaction, 
is  rapid  and  brief,  and  recovery  usually  quickly  follows. 

In  old  and  chronic  cases,  such  as  lumbago,  the  reaction' 
is  delayed,  occasionally  not  appearing  till  after  fifteen  or 
twenty  packs  ;  but  the  case  then  makes  satisfactory  progress, 
and  the  lumbago  is  often  banished  for  yeairs.  Occasionally 
patients  complain  that  the  pains  wander  from  the  back  to 
the  thigh  or  chest,  etc.  The  application  should  follow  up- 
the  pains,  which  gradually  diminish,  disappearing  last  at  the 
place  where  they  began. 

Old  injuries  :  high  temperatures  can  nearly  always  be- 
prescribed  from  the  first. 

Neuritis. — In  all  applications  to  painful  nerves,  low  or 
moderate  temperatures  must  be  employed,  beginning  at 
first  as  low  as  40°  to  43 '3°  C,  and  for  ten  minutes  or  sO' 
only.  Each  case  must  be  judged  by  itself,  for  there  are 
few  in  which  excellent  results  are  not  obtained  if  sufficient 
care  be  taken.  Occasionally  there  are  inveterate  cases  of 
sciatica  that  show  no  signs  of  improvement,  even  after 
prolonged  applications. 

In  these  cases,  if  no  reaction  has  taken  place  after  a  few 
packings,  the  reaction  must  be  enforced.  This  is  done  by 
applying  two  or  three  packs  at  54*5°  C.  When  the  reaction 
occurs,  lower  the  temperature  to  46°  C,  and  let  it  remain 
at  this.  As  soon  as  the  pain  lessens,  the  packs  should  be- 
applied  every  other  day,  and  later  twice  a  week. 

Alcoholic  neuritis  (multiple)  may  be  successfully  treated 
with  fango. 

Abdominal  or  Pelvic  Neuroses. — High  temperatures 
are  most  useful  here.     The  whole  abdominal,  lumbar,  and' 


SAND     BATHS  91 

sacral  regions  are  treated.  This  is  mostly  of  service  in 
gynaecological  patients. 

Tabes  Dorsalis. — For  the  shooting  pains,  four  or  five 
packs,  applied  every  second  day,  often  produce  a  very 
satisfactory  result.  The  pains  diminish,  and  often  dis- 
appear entirely. 

In  chronic  bronchial  catarrh,  pleuritic  effusion,  abdominal 
diseases,  gallstone  colic,  and  pelvic  disorders,  the  highest 
temperatures  must  be  used. 

Gout. — In  acute  gout,  fango  is  especially  useful ;  it  allays 
the  pain  and  reduces  the  duration  of  the  attack.  After 
three  or  four  days  improvement  sets  in,  and  by  the  seventh 
day  an  excellent  result  is  nearly  always  produced,  whilst 
otherwise  the  patient  would  have  had  to  stay  in  bed  or  on 
an  easy  chair  for  three  or  four  weeks.  In  forty  cases  of 
acute  gout,  we  had  only  one  where  the  effect  was  not  so 
prompt. 

SAND    BATHS. 

The  body,  or  a  portion  of  it,  is  immersed  in  sand  heated 
to  a  temperature  of  from  42*4°  to  54'4°  C.  Profuse  perspi- 
ration results,  with  reddening  of  the  skin  upon  which  the 
sand  cakes. 

The  body  temperature  rises  3°  or  4°,  owing  to  delayed  heat 
loss.  These  baths  are  used  at  Harrogate,  and  at  Lavey,  in 
Switzerland. 

The  sand  was  formerly  warmed  by  exposure  to  the  sun, 
but  is  now  usually  heated  in  special  ovens.  Fine  hard 
sea  or  river  sand  is  used.  The  heated  sand  is  laid  for  a 
depth  of  six  to  twelve  inches  on  the  bottom  of  the  tub.  and 
the  patient  lies  down  in  this.  His  head  is  raised  on  a  pillow, 
and  the  body  carefully  covered  with  warm  blankets. 

The  temperature  of  the  sand  to  begin  with  is  from 
45°  to  50°  C,  and  may  be  maintained  by  means  of  hot 
pipes  in  the  floor  of  the  tub.  Perspiration  rapidly  occurs, 
and  is  freely  absorbed  by  the  sand,  so  that  the  patient 
experiences  no  discomfort.  Pulse  and  respiration  are 
quickened. 

Duration,  one  to  one  and  a  half*  hours.  The  patient 
is  treated  as  after  the  steam  cabinet  or  Turkish  bath. 


92  NATURAL     THERAPY 

Indications. — These  baths  are  specially  indicated,  in 
preference  to  vapour  or  water  baths,  where  a  powerful 
skin  stimulation  with  increase  in  body  heat  is  desired. 
They  are  of  service  in  various  joint  affections  of  a  gouty 
or  rheumatic  nature,  in  neuralgia,  peripheral  neuritis,  and 
in  chronic  inflammatory  affections  of  the  uterus. 

They  should  not  be  given  to  patients  who  are  suffering 
from  cardiac  disease  of  an  organic  nature,  phthisis  pulmon- 
alis,  or  to  pregnant  women. 

BRINE    BATHS    (Sool-Bader). 

These  baths  are  prepared  from  water  containing  sodium 
chloride,  or  by  adding  saline  to  ordinary  water.  Powders 
may  be  used  which  are  prepared  from  suitable  mineral 
waters  by  concentration. 

The  salts  are  chiefly  chlorides  of  sodium,  magnesia,  and 
calcium.  From  15  to  20  lbs.  are  necessary  to  make  a  full 
bath  to  contain  3  per  cent.  The  bath  water  should  con- 
tain not  less  than  1-5  per  cent  of  saline  matter,  and  the 
amount  may  be  increased  up  to  5  or  6  per  cent.  The  usual 
temperature  of  the  bath  is  35°  C. 

The  action  of  these  baths  depends  chiefly  on  the  irritative 
effect  of  the  saline  matter  on  the  patient's  skin,  which  is 
rendered  somewhat  hypersesthetic.  Production  of  CO^  is 
increased  and  the  blood-pressure  rises.  The  baths  possess 
a  somewhat  diuretic  action,  and  the  urea  and  chlorides 
are  excited  and  increased.  The  effect  is  greatest  if  the 
saline  percentage  of  the  bath  be  low.  With  the  increased 
metabolism  the  patient's  appetite  improves. 

Indications. — These  baths  are  of  value  in  the  treatment 
of  various  chronic  inflammatory  disorders  of  the  pelvis  in 
the  female,  such  as  perimetritis  and  parametritis,  in  chronic 
joint  rheumatism,  and  neuritis. 

MEDICATED    BATHS. 

Vegetable,  animal,  or  mineral  matter  are  added  to  the 
water  in  these  baths  in  order  to  modify  their  action  in 
various  ways.  Among  the  substances  employed  are  dried 
plants,  such  as  camomile,  thyme,  spearmint,  lavender,  oil 
of  cade,  etc.  An  alcoholic  extract  of  these  is  added  to 
the  bath  water. 


MEDICATED     BATHS  93 

Midgeley's,  Manchester,  prepare  excellent  powders  for 
"  medicating  "  baths,  in  great  variety. 

A  common  form  of  bath  employed  is  the  pine  bath, 
prepared  from  pine  needles,  or  young  shoots  of  firs  or  pine 
trees,  or  an  alcoholic  extract.* 

Bran  baths  have  a  soothing  effect  on  various  irritative 
skin  conditions,  and  mustard  baths,  prepared  from  mustard 
flour  or  mustard  bran,  are  useful  as  derivatives  in  various 
internal  inflammations  and  congestions. 

A  combination  of  mustard  and  bran  is  often  used.  A 
tablespoonful  of  mustard  flour  to  a  teacupful  of  bran  in 
each  gallon  of  hot  water. 


*  Langbein's  Coniferol   tablets,  obtainable  from  the  Hygienic  Resorts 
Bureau,  Chancery  Lane,   W. 


94 


Section    II. — Heat   and  Light   in    the 
Treatment    of  Disease. 


CHAPTER   VII. 
THERMOTHERAPY. 

GENERAL    PRINCIPLES. 

'T'HE  use  of  heat,  in  one  form  or  other,  in  therapeutics, 
dates  back  to  the  dim  and  distant  ages  of  remotest 
antiquity  ;  even  animals,  when  ill,  instinctively  have 
recourse  to  the  radiant  heat  of  the  sun.  Doubtless  the 
first  idea  of  the  use  of  heat  as  a  curative  agent  arose  from 
the  beneficial  effects  experienced  from  submitting  the  body 
to  the  influence  of  the  solar  rays. 

The  therapeutical  applications  of  heat  are  innumerable, 
and,  with  the  progress  of  science,  have  gradually  ex- 
tended their  range  from  the  linseed  poultices  of  former 
times  to  the  modern  and  elegant  appliances  for  treatment 
by  means  of  moist  or  dry  heat  ;  from  the  old  Roman 
sweating-houses  to  the  luxurious  and  well-appointed 
Turkish  baths  of  the  present  day. 

Although  originally  practised  by  enthusiasts  on  more 
or  less  empiric  lines — in  common  with  many  other  forms 
of  treatment  which  have  subsequently  received  the  warm 
approval  of  medical  men  and  scientists — the  use  of  heat  in 
its  various  forms  has  during  the  last  century  been  the  subject 
of  study  by  numerous  medical  men  throughout  the  world. 

In  1840,  Guyot  issued  his  "  Traite  de  ITncubation." 
It  is  the  first  serious  study  on  hot  air  and  the  employment 
of  high  temperatures  for  the  alleviation  of  pain,  especially 
with  reference  to  affections  of  the  bones. 

In  1844,  Chautard,  perceiving  the  value  attaching  to 
luminous  radiant  heat,  strongly  recommended  its  adoption 


THERMOTHERAPY  95 

in  the  treatment  of  rheumatism.  Then  came  Fodere,  of 
Strasburg,  and  Marchand,  of  Bordeaux,  who  studied  the 
action  of  sand  baths,  heated  by  solar  rays,  a  form  of  treat- 
ment, known  as  arenation,  which  is  practised  in  some  places  at 
the  present  day,  e.g.,  Battle  Creek,  Michigan  {Plate  XXIV). 
Coming  to  more  recent  times,  the  works  on  hot-air  and 
vapour  baths,  and  on  the  various  applications  of  heat,  are 
so  numerous  that  their  bare  enumeration  would  fill  several 
pages. 

Heat  may  be  employed  in  Three  Different  Forms  ; — 
I.  Moist  heat  ;     2.  Dry  heat  ;     3.  Luminous  radiant  heat. 

1.  Moist  Heat. — ^Without  going  into  the  question  of 
•ordinary  baths,  poultices,  fomentations,  etc.,  we  will  now 
consider  what  takes  place  in  vapour  baths,  of  which  the 
temperature  varies  from  24°  C.  to  55°  C.  The  enclosure 
within  which  such  baths  are  given  consists  of  a  closed 
chamber  into  which  is  allowed  to  iiow  either  pure  water 
vapour  or  vapour  charged  with  medicinal  substances.  The 
patient  usually  bears  without  inconvenience  a  temperature 
of  from  24°  C.  to  35°  C,  but  beyond  this  latter  temperature 
and  up  to,  say,  44°  C,  the  respiration  and  circulation  are 
very  noticeably  accelerated,  and  such  untoward  events 
as  vertigo,  loss  of  consciousness,  congestion,  haemorrhage, 
etc.,  are  to  be  feared.  These  are  due  to  the  hot  vapour, 
which  renders  respiration  laborious  and  painful,  and  also 
to  the  obstruction  offered  to  the  evaporation  of  the  moisture 
given  off  from  the  body  in  an  atmosphere  already  super- 
saturated with  moisture.  In  order  to  get  rid  of  the  first  of 
these  difficulties,  there  has  been  introduced  the  box  bath, 
which  consists  of  an  enclosure  within  which  only  the  body  is 
enveloped  in  vapour,  the  head  being  outside  the  box,  thus 
permitting  the  lungs  to  receive  air  from  without.  In  spite 
of  this,  when  one  enters  a  room  in  which  such  box  baths 
are  being  given,  the  high  temperature  is  generally  very 
noticeable,  as  are  also  the  humidity  and  disagreeable  odour 
of  the  atmosphere  which  one  breathes.  It  is  practically 
impossible  to  remedy  the  difficulty  of  evaporation  of  the 
perspiration. 

2.  Dry  Heat. — Among  the  applications  of  dry  heat  in 
which  air  does  not  play  the  part  of  the  conducting  medium, 
.and  in  which  the  temperature  does  not  get  beyond  49°  C. 


96  NATURAL    THERAPY 

to  55°  C,  are  bran,  salt,  or  hot  sand  compresses,  dry 
fomentations,  etc. 

The  hot-air  bath  represents  the  more  general  application 
of  dry  heat ;  the  temperature  varies  from  40°  C.  to  74°  C. 
and  may  even  reach  112°  C,  the  maximum  temperature 
bearable  for  any  length  of  time  ;  but  it  is  not  prudent 
to  submit  patients  to  this  latter  temperature. 

In  1893  Tallerman  demonstrated  the  possibility  of 
attaining  with  dry  heat  temperatures  unknown  until  then. 
His  apparatus  consists  of  a  metal  cylinder  heated  by 
numerous  gas  jets.  The  cylinder  is  closed  at  one  end,  with 
the  exception  of  one  small  opening  where  a  ventilator  is 
fixed.  At  the  other  end  is  fixed  a  movable  screen  of  special 
cloth,  with  an  opening  in  the  centre  through  which  the 
affected  limb  is  passed.  The  apparatus  thus  consists 
of  a  closed  space  with  a  means  of  securing  ventilation. 
Considerable  experience  in  English  and  American  hospitals 
demonstrates  that  a  temperature  of  148°  C.  can  be  borne 
without  inconvenience,  and  gives  good  therapeutic  results 
in  some  cases.  The  apparatus  is  to  all  intents  and  purposes 
a  gas  oven,  and  products  of  combustion  are  distinctly 
perceptible. 

3.  Luminous  Radiant  Heat. — This  is  either  natural  or 
artificial  ;  natural  in  sun  baths  ;  artificial  in  the  Dowsing 
baths.  The  latter  system  of  baths  possesses  many  and 
considerable  advantages  over  all  other  systems,  and  permits 
of  a  temperature  of  upwards  of  260°  C.  being  attained,  and 
maintained  with  safety. 

In  order  to  fully  appreciate  the  medical  value  of  luminous 
radiant  heat,  it  is  necessary  to  explain  here  certain  of  its 
physical  properties  which  are  but  little  understood  at  the 
present  day. 

SOME    PHYSICAL    FACTS    IN     REGARD    TO 
LUMINOUS    RADIANT    HEAT. 

Luminous  radiant  heat — of  which  the  sun  represents 
the  best  possible  example — is  the  conjunction  of  radiant 
heat  with  light  and  certain  chemical  rays.  All  combustion 
with  flame  creates  luminous  radiant  heat,  but  it  is  not 
always  necessary  to  use  combustion,  in  the  chemical  sense 


THERMOTHERAPY 


97 


of  the  word,  to  obtain  this  mode  of  transformation  of 
energy.  Electricity  can  transform  itself  directly,  in  vacuo, 
into  luminous  radiant  heat.  This  is  the  case  with  the 
Dowsing  lamp,  which  emits  simultaneously  heat  rays 
and  light  rays  {See  Fig.  42). 

Radiant  heat,  light  rays,  and  chemical  rays  are  three 
types  of  radiant  energy  ;  from  the  physical  point  of  view 
there  is  no  essential  difference  between  them,  and  their 
laws  of  propagation  are  identical. 

Radiant  heat  is  that  which,  emanating  from  a  heated  body, 
passes  through  other  bodies,  described  as  diathernianous ,  as 
light  passes  through  diaphanous  bodies. 


ULTRA    RED 


< 

rr 

z. 

0 

z 

uJ 

0 

1.7 

ILI 

r 

< 

ID 

UJ 

-I 

0 

Z 

0 

y- 

IX. 

0 

> 

0 

CD 

>• 

ULTRA    VIGlET 


DOWSINCS   RAYS 


FIN5ENS     RAYS 


Fig.  4 J 


A  part  of  the  sun's  heat  travels  through  the  atmosphere 
as  light,  without  being  absorbed  in  it ;  the  fire  from 
the  hearth  warms  us  at  a  distance  without  the  heat  which 
it  emits  being  absorbed  by  the  air  which  separates  it  from 
us.     This  is  what  is  known  as  radiation. 

Radiation  consists  in  the  vibrations  of  ether  produced 
by  the  impulse  of  molecular  movements  of  a  radiant  bod}'. 
Luminous  rays  are  perceptible  to  us  by  the  eyes,  and  heat 
rays  by  the  skin  and  flesh,  but  the  invisible  rays  of  heat, 
the  luminous  rays  of  light,  and  the  chemical  rays  are  each 
represented  by  ether  vibrations,  only  distingaishable  by 
difference  in  length  of  wave.     Tyndall  demonstrated  this 

7 


98  NATURAL     THERAPY 

in  his  studies  on  the  spectrum  ;  in  fact,  when  we  observe 
the  obscure  region  of  the  spectrum,  we  see  that  the  heat 
rays  become  more  and  more  intense  in  proportion  to  the 
proximity  of  the  luminous  rays  ;  at  the  same  time  the  heat 
waves  acquire  a  greater  ampHtude,  causing  greater  energy 
of  vibration,  the  energy  of  vibration  being  proportional 
to  the  square  of  the  amplitude.  Thus,  to  obtain  high 
temperatures,  a  source  of  luminous  heat  is  preferable  to 
all  others. 

In  spite  of  the  identity  in  origin  of  obscure  and  luminous 
heat,  it  is  not  less  true  that  luminous  heat  possesses 
properties  peculiar  to  itself. 

Practically,  the  transmission  of  obscure  heat  is  effected 
by  convection,  and  consequently  indicates  the  raising  of 
the  temperature  of  the  surrounding  atmosphere  ;  for 
example,  to  raise  by,  say,  thirty  degrees,  the  temperature 
of  a  body  separated  some  distance  from  a  source  of  obscure 
heat,  it  is  absolutely  necessary  that  the  atmosphere  of  the 
intervening  space  be  also  raised  by  thirty  degrees. 

Luminous  radiant  heat  will  effect  its  purpose  without 
raising  the  temperature  of  the  surrounding  atmosphere  ; 
its  rays,  like  the  rays  of  the  sun,  do  not  by  convection  carry 
the  heat  from  point  to  point,  but  merely  energy  in  the 
shape  of  vibrations,  which  energy  is  transformed,  or 
converted,  into  effective  heat  in  encountering  obstructing 
bodies. 

Luminous  radiant  heat  travels  through  space.  It  may 
be  diffused  as  light,  and  reflected  and  directed  by  means 
of  suitably  arranged  reflectors.  This  may  be  readily 
demonstrated  by  arranging  opposite  each  other,  some  little 
distance  apart,  two  large  spherical  or  parabolic  mirrors 
of  burnished  copper  in  such  a  manner  that  their  axes  are 
coincident,  and  placing  a  piece  of  live  coal,  or  other  lighted 
substance,  in  front  of  the  one,  and  a  piece  of  tinder  in  front 
of  the  other,  when  it  will  be  found  that  the  tinder  almost 
immediately  bursts  into  flame. 

Luminous  rays  and  chemical  rays  play  an  important 
part  in  luminous  radiant  heat,  and  it  may  be  useful  at  this 
point  to  mention  some  features  of  special  interest.  Under 
certain  conditions,  light  becomes  converted  into  heat. 
A  striking  example  of  this  is  shown  in  connection  with  a 


THERMOTHERAPY  99 

conservatory.  If,  when  the  sun  is  shining  brightly,  all 
ventilation  is  stopped  for  a  few  hours,  the  heat  within 
the  conservatory  becomes  intolerable.  The  heat  rays 
alone  are  not  responsible  for  this  increase  in  temperature, 
for,  as  is  well  known,  heat  rays  only  penetrate  through 
glass  to  the  extent  of  33  per  cent,  a  percentage  quite 
insufficient  to  account  for  the  rapid  rise  in  temperature 
within  the  conservatory.  The  explanation  is  to  be  found 
in  the  fact  that  the  luminous  rays,  which  pass  through 
glass  practically  without  diminution,  coming  into  contact 
with  the  plants  and  other  objects  within  the  conservatory, 
are  absorbed  in  such  subjects,  and  thus  converted  into 
effective  heat.  Tyndall  has  demonstrated  the  same  thing 
by  the  following  ingenious  experiment.  He  passed  a  beam 
of  electric  light  through  water,  to  absorb  the  heat  rays, 
and  then,  by  passing  the  resultant  rays  through  a  lens  of 
ice,  he  set  fire  to  some  black  paper  and  ignited  gun-cotton 
on  the  other  side,  showing  that  it  was  not  the  heat  rays 
which  brought  about  that  result,  but  the  light  rays.  In 
other  words,  the  wave  lengths  were  altered,  they  were 
lowered  in  refrangibility,  and  converted  into  heat. 

Certain  substances,  amongst  others  platinocyanide  of 
barium,  have  the  property  of  absorbing  rays  of  a  certain 
wave  length  and  of  emitting  rays,  more  or  less  luminous, 
of  a  different  wave  length.  This  interesting  phenomenon 
constitutes  fluorescences,  of  which  the  radioscope  represents 
the  most  important  application. 

Thus  we  see  that  luminous  radiant  heat  is  formed  by 
the  blending  together  of  heat  rays,  luminous  rays,  and 
chemical  rays  ;  but  it  is  possible  to  eliminate  either  one 
or  other,  and  to  have  separately  either  heat  rays,  light 
rays,  or  chemical  rays. 

In  order  to  separate  heat  rays  from  luminous  rays,  we 
utilize  the  fundamental  difference  between  their  action 
on  the  bodies  they  meet.  Amongst  such  bodies,  some 
completely  stop  the  passage  of  radiant  heat  and,  for  this 
reason,  are  called  athermanous  ;  others,  which  permit 
the  passage  of  radiant  heat,  are  called  diathermanous. 
Diathermanous  bodies  are  not  necessarily  transparent,  nor 
are  athermanous  ones  necessarily  opaque.  An  alum  solution 
allows  the  light  to  pass  through,  but  completely  stops  the 


100  NATURAL     THERAPY 

passage  of  heat.  Iodine,  on  the  other  hand,  in  solution  of 
bisulphide  of  carbon,  allows  the  invisible  heat  rays  to 
pass,  but  effectively  obstructs  the  light  rays.  These  facts 
are  easily  demonstrated.  Water  will  boil  by  light  which 
has  passed  through  iodine  and  is  concentrated  in  a  glass 
tube  containing  water.  If  the  iodine  is  replaced  by  an 
alum  solution,  the  boiling  ceases  instantly. 
Summarizing  briefly,  it  may  be  stated  that  : — 

1.  Luminous  radiant  heat  is  made  up  of  different  radia- 

tions or  vibrations,  which  can  be  separated  one 
from  the  other. 

2.  It  can  be  directed  on  to  a  body  without  raising  the 

temperature  of  the  surrounding  atmosphere. 

3.  It  can  penetrate  glass  without  diminution  of  potency. 

4.  It  can  be  reflected  by  means  of  reflectors. 

5.  It  can  be  so  diffused  by  means  of  special  appliances, 

that  very  high  temperatures  may  be  attained  by  the 
air  enclosed  in  a  given  space. 

The  PhYsiological  Action  of  luminous  radiant  heat, 
which  is  composed  of  heat,  light,  and  chemical  rays,  each 
possessing  specific  and  important  properties,  is  determined 
by  the  combined  action  of  all  such  rays  upon  the  body. 
This,  from  the  therapeutic  point  of  view,  is  of  much  interest, 
as  it  is  such  a  combination  of  rays  which  in  practice  is  most 
often  brought  into  requisition. 

One  remarkable  feature  at  once  attracts  attention.  The 
human  body  can  bear,  with  luminous  radiant  heat,  much 
higher  temperatures  than  have  hitherto  proved  possible 
by  any  other  application  of  heat.  The  complete  or 
whole  body  bath  can  be  used  without  danger  at  a  tempera- 
ture of  upwards  of  205°  C.  ;  this  bath  is  usually  given 
with  a  temperature  ranging  approximately  from  149°  to 
205°  C,  while  with  the  local  bath  a  temperature  of  upwards 
of  260°  C.  may  be  attained. 

At  first  sight  it  would  naturally  be  thought  that  such 
high  temperatures  must  necessarily  be  productive  of 
considerable  risk  to  the  human  organism.  In  hot-air 
(Turkish)  baths,  the  temperature  rarely  rises  beyond  79°  C. 
Cutaneous  perspiration  and  respiration  are  the  only  means 
at  the  disposal  of  the  body  for  maintaining  its  temperature 
under  such  conditions.     This  remains  equally  true  when 


THERMOTHERAPY  loi 

using  the  Dowsing  system,  with  this  very  important 
difference,  that  the  action  of  the  skin  and  lungs  can  be 
raised  to  the  highest  possible  pitch,  because  the  respiration 
of  the  patient  is  not  affected,  the  air  inhaled  being  of  the 
normal  temperature.  Cutaneous  perspiration  is  an  example 
of  the  well-known  fact  that  water  cannot  be  converted  into 
vapour  without  absorbing  and  rendering  latent  a  consider- 
able amount  of  heat.  The  quantity  of  water,  in  the  form 
of  vapour,  exhaled  by  the  human  body  has  been  estimated 
at  32  ounces  per  diem.  The  heat  absorbed  and  rendered 
latent  by  such  evaporation  is,  according  to  the  most  careful 
calculations,  equal  to  that  which  would  raise  the  same 
weight  of  water  from  0°  to  625°  C. 

Cutaneous  perspiration  can  thus  be  considered  a  most 
powerful  agent  in  regulating  the  temperature  of  the 
human  body,  and  observation  demonstrates  that  it  becomes 
more  active,  and  therefore  absorbs  more  heat,  as  the 
temperature  around  it  is  raised.  But  in  order  to  attain  this 
result,  it  is  essential  that  the  air  in  contact  with  the  skin 
be  kept  free  from  moisture,  the  presence  of  which  tends 
to  the  reduction  of  the  perspiration,  and  in  fact  stops  it 
entirely  when  the  atmosphere  becomes  supersaturated. 
To  ensure  the  requisite  dryness  of  air,  it  is  therefore 
essential  that  some  more  or  less  perfect  system  of 
ventilation  should  be  obtained.  It  is  for  this  reason 
that  the  ordinary  hot-air  bath,  having  no  appreciable 
ventilation,  may  become  a  source  of  no  little  danger  to 
the  patient. 

The  evaporation  which  takes  place  in  the  pulmonary 
cavities  constitutes  a  further  means  which  the  body  possesses 
for  maintaining  its  proper  temperature  in  a  superheated 
atmosphere.  Its  intensity  is  in  inverse  ratio  to  the  moist 
condition  of  the  air. 

To  undergo  high  temperatures,  it  is  essential  that  the 
temperature  of  the  body  should  remain  normal.  To 
accomplish  this,  the  heat  which  is  given  off  must  be  almost 
entirely  converted  into  another  form  of  energy,  viz.,  the 
latent  heat  of  vapour. 

The  Dowsing  appliances,  utilizing  luminous  radiant 
heat  by  direct  radiation  without  heating  the  surrounding 
atmosphere,  do  not  increase  the  temperature   of  a  room, 


102  NATURAL     THERAPY 

and  in  no  way  affect  the  breathing  of  the  patient  ;  and 
by  diffusing  the  heat  in  a  confined  space,  automatically 
ventilated,  the  same  results  follow.  The  constant  renewal 
of  the  air  in  contact  with  the  body  of  the  patient  securing 
freedom  from  saturation,  enables  temperatures,  hitherto 
unknown,  to  be  obtained  by  the  use  of  luminous  radiant 
heat. 

Remarkable  potency  and  uniformity  are  characteristics  of 
the  physiological  action  of  these  high  temperatures,  which 
have  been  closely  studied  by,  amongst  others,  Hedley 
and  Douglas  Kerr,  of  Bath.  The  results  obtained  by 
them,  which  are  very  similar  to  those  given  by  Chretien, 
of  the  Salpetriere  Hospital,  may  briefly  be  stated  as 
follows  : — 

Very  marked  redness  of  the  skin,  due  to  the  dilatation 
of  the  subcutaneous  blood-vessels  ;  more  or  less  profuse 
perspiration  ;  more  or  less  rapid  acceleration  of  the  pulse  ; 
speedy,  sometimes  immediate,  alleviation  of  pain  ;  tempo- 
rary increase  of  the  temperature  of  the  body  ;  increase 
of  the  sohd  matter  of  the  urine,  particularly  of  the  urea 
and  uric  acid,  and  greater  elimination  of  carbonic  acid  by 
the  lungs. 

The  redness  of  the  skin  is  not  uniform,  assuming  a  red- 
marbled  appearance  caused  by  a  dilatation  of  the  blood- 
vessels forming  the  capillary  network  in  the  cellular  spaces 
of  the  corium.  The  cutaneous  perspiration  differs  in 
patients,  but  is  always  more  profuse  in  this  than  in  ordinary 
hot-air  baths.  The  perspiration  increases  with  the  heighten- 
ing of  the  temperature  and  spreads  all  over  the  surface  of 
the  body,  even  in  local  applications,  when  the  area  under 
treatment  may  be  very  limited. 

The  acceleration  of  the  pulse,  although  variable,  is  less 
pronounced  than  is  the  case  in  hot-air  baths,  and  results 
from  the  dilatation  of  the  peripheral  blood-vessels,  which 
facihtate  the  action  of  the  heart  and  permit  of  more 
complete  and  stronger  contractions.  An  hour  after  a 
luminous  radiant-heat  bath,  the  pulse  becomes  slower  but 
stronger  than  before,  especially  in  cases  of  patients 
suffering  from  weak  hearts. 

The  sedative  action  of  the  luminous  radiant-heat  treat- 
ment is  very  marked.      In  cases  of  acute  gout,  its  action  is 


THERMOTHERAPY 


103 


CKN'IICRADK.  FAHRKNHEIT. 

260 500... ^ 


20f.^.. 


."too. 


1487. 300 


116  . 
100. 

62. 


.240. 


.2/2 
.200. 

.180. 


S4'4. 130 I .  ,, - 


^9 120  

46  115     -- 

Over  -to 105 '  , 

31  lOO 

35 

30 


24 
15 


75-2 -- 


Under  12 32- 


Radiant  Heat  Batli,  maximum  bear- 
al)le  heat  without  danger,  for 
the  treatment  of  single  limbs.    • 


Radiant  Heat  Bath,  maximum  bear- 
al)!e  heat  for  full  body  bath. 


Radiant  Heat  Bath,  comfortable. 


—   Very  liot  Turkish   Hath. 

■  -   Water  boils. 

--   "Calidarium" — Turkish  Bath. 

"•   "  Tepidarium  " — Turkish  Bath. 

,.-   Fango  ;\hul   Bath,  bearable. 
,.  Vapour  Balh,   unbearable. 

.-    Fango  Mud  Hath,  comfortable. 
-■  Very  Hot       -s 


\V.A.TER 
APPLICATIONS. 


-  Hot 

-  Warm 

-  'I'epid 
"  Cool 
■  Cold 
•  Very  Cold 

1^'S-   43- — Chart   Showing   Ther.momktkic   Eiiuivai.e.n'is. 


104  NATURAL     THERAPY 

practically  immediate,  freedom  from  pain  being  experienced 
almost,  if  not  quite,  from  the  first  application  of  the  rays 
to  the  body ;  in  cases  of  sprains,  contusions,  articular 
or  muscular  rheumatism,  and  neuralgia,  no  inconsiderable 
diminution  of  pain  is  experienced  from  the  first,  with 
an  increasing  feeling  of  relief  after  each  succeeding 
application. 

In  a  Dowsing  bath  having  a  temperature  of  about  218"^  C. 
and  a  duration  of  from  thirty  to  forty  minutes,  the 
temperature  of  the  body,  taken  under  the  tongue,  shows 
a  gradual  increase  of  from  six-  to  eight-tenths  of  a  degree ; 
rarely  more  than  a  degree.  Within  about  twenty  minutes 
after  the  bath  the  temperature  returns  to,  and  remains, 
normal. 

In  a  Turkish  bath,  on  the  other  hand,  a  stay  of  only  ten 
minutes,  with  a  temperature  of  about  107°  C,  is  sufficient 
to  raise  the  temperature  of  the  body,  taken  under  the 
tongue,  more  than  a  degree  (Dobson).  Twenty  to  thirty 
minutes  after  leaving  the  bath  the  temperature  has  not 
only  fallen  to  the  initial  point,  but  has  actually  gone  below 
it  (Hoppe). 

The  increase  in  ehmination  of  the  solid  matters  in  the 
urine,  particularly  of  the  urea  and  uric  acid,  seems  to  be 
mainly  brought  about  by  the  increase  in  the  temperature 
of  the  body,  by  the  more  rapid  flow  of  the  blood  through 
the  expanded  blood-vessels,  and  by  the  profuse  perspiration 
which  is  induced.  A  remarkable  feature  is  that,  during 
a  course  of  the  Dowsing  baths,  it  is  generally  found 
that  there  is  a  greater  volume  of  urine  discharged  than 
usual. 

There  is  always  a  very  considerable  elimination  of  carbonic 
acid  from  the  lungs,  resulting  in  a  general  stimulation  of 
the  digestive  organs.  There  is  sometimes  a  slight  accelera- 
tion in  respiration,  but  usually  it  remains  normal. 

The  combination  of  luminous  rays,  chemical  rays,  and 
heat  rays  gives  to  luminous  radiant  heat  properties  not 
possessed  by  obscure  heat.  Two  experiments  made  by 
Bain,  of  Harrogate,  show  very  important  results.  In  the 
first  experiment,  the  hind  leg  of  a  dog — ansesthetized  with 
ether — was  placed  in  a  non-luminous  hot-air  case.  In  the 
second  experiment,  with  the  leg  under  the  same  conditions, 


THERMOTHERAPY  105 

the  Dowsing  apparatus  was  used,  and  the  leg  exposed  to 
luminous  radiant  heat.  The  results  obtained  in  each  case 
were  as  follows  : — 


Obscure  or  Xon- 

Luminous 

Luminous  Heat. 

Heat. 

Temperature  of  the  Air  in  Case 

150°  c. 

120°  c 

Elevation  of  the  Temperature  of  the 

Body 

•5" 

•1° 

Elevation  of  the  Temperature  of  the 

Limb  .  . 

1-8° 

4-2° 

From  the  physiological  point  of  view,  it  is  not  possible 
to  form  conclusions  applicable  to  human  beings,  owing  to 
the  difference  in  the  cutaneous  functions,  but  it  is  never- 
theless clear  that  luminous  heat  at  120°  C.  brings  about 
a  rise  of  temperature,  both  local  and  general,  greater  than 
is  produced  by  non-luminous  heat  at  150°  C,  showing  that 
luminous  radiant  heat  possesses  greater  penetrative  power 
than  non-luminous. 

Analysis  of  the  various  results  obtained  under  the 
influence  of  luminous  radiant  heat  enables  us  clearly  to 
trace  its  curative  effect  in  various  diseases,  and  its  remark- 
ably sedative  influence  in  the  alleviation  of  pain.  Hedley 
has  given  a  very  good  explanation  of  this.  He  takes,  as 
an  example,  one  of  the  various  forms  of  rheumatic  or  gouty 
arthritis,  for  which  the  Dowsing  baths  are  specially  recom- 
mended. Such  an  example,  however,  is  complicated  by 
conditions  peculiar  to  itself,  and  it  is  perhaps  simpler  to 
consider  the  case  of,  say,  a  recent  sprain,  which  will 
illustrate  much  more  clearly  what  takes  place. 

As  an  immediate  consequence  of  such  an  injury,  the 
distention  of  the  ligaments,  the  more  or  less  pronounced 
strain,  and  the  laceration  of  the  fibrous  tissue,  cause  an 
extravasation  of  blood  in  the  tissues,  and  often  in  the  joint 
itself.  A  more  or  less  extensive  swelling  rapidly  sets  in, 
followed  by  signs  of  local  inflammation.  The  pain  is 
intense,  and  on  the  slightest  movement  becomes  excruci- 
ating. At  the  same  time,  both  the  larger  and  smaller 
blood-vessels  become  dilated,  with,  consequently,  a  larger 
flow  of  blood  through  them  than  is  usual.     The  dilatation 


106  NATURAL     THERAPY 

of  the  capillaries  fed  by  the  smaller  blood-vessels  in  question 
is  only  proportionately  less  pronounced,  and  is  brought 
about  primarily  by  the  flow  of  blood  being  greater  than 
they  can  normally  contain.  The  normal  difference  of 
pressure  between  the  blood  of  the  capillaries  and  the  lymph 
contained  in  the  lymphatic  spaces  increases  considerably, 
and  brings  about  the  diffusion  of  a  certain  amount  of 
lymph.  It  is  even  possible  that  the  capillary  circulation 
may  be  stopped  by  congestion  brought  about  by  the 
adhesion  of  red  and  white  corpuscles  ;  in  this  case  the 
increased  activity  of  the  circulation  is  followed  by  stagna- 
tion, but  the  outflow  of  the  cellular  elements  being  very 
active,  their  disintegration  will  rapidly  produce  coagulation 
of  the  lymph  surrounding  the  seat  of  injury. 

The  surrounding  tissues,  which  are  comparatively  much 
less  hurt,  become  swollen,  because  the  lymphatics  are 
unable  to  absorb  the  products  of  the  vascular  exudations, 
and  are  distended  by  the  lymph,  which  does  not  coagulate, 
since  it  is  no  longer  in  contact  with  elements  in  course  of 
disintegration.  The  painful  symptoms  result  mostly  from 
the  pressure  produced  by  an  exudation  which  has  no  outlet 
in  a  joint  protected  by  ligaments  and  fibrous  tissue  which 
cannot  expand.  The  lymphatic  system,  by  extra  activity 
of  its  absorptive  functions,  endeavours  to  counteract  this 
abnormal  pressure,  but  the  compensation  is  not  sufficient, 
and  more  or  less  swelling  is  the  rule. 

What  is  the  action  of  luminous  radiant  heat  in  such 
cases  ?  Shortly  after  submitting  the  limb  to  the  influence 
of  luminous  radiant  heat,  the  skin  becomes  red,  and  profuse 
perspiration  sets  in.  The  redness  of  the  skin  is  due  to  the 
dilatation  of  the  cutaneous  blood-vessels,  whilst  the 
perspiration  results  from  :  (i)  The  dilatation  of  the  blood- 
vessels, particularly  of  those  capillaries  which  are  in  intimate 
relation  to  the  perspiring  and  sebaceous  glands  and  follicles  ; 
(2)  The  direct  stimulation  of  the  cellular  elements  and 
glands  by  the  various  radiations. 

Therapeutic  Indications, 

All  affections  which  are  benefited  by  hot-air  baths, 
whether  local  or  general,  are  very  successfully  treated 
by   luminous   radiant   heat.      Owing   to   the    perfection   in 


THERMOTHERAPY  107 

ventiiation  attained  by  the  Dowsing  apparatus,  it  is  possible, 
without  risk,  to  submit  patients  to  temperatures  varying 
from  150°  to  232°  C.  in  the  complete — or  whole-body — bath, 
while  with  the  appliance  for  local  baths,  a  temperature  of 
upwards  of  260°  C.  may  safely  be  given. 

The  physiological  action,  proved  by  numerous  actual 
tests,  enables  the  results  which  may  be  anticipated  in  the 
treatment  of  various  affections  to  be  set  out  with  a  very 
considerable  degree  of  certainty.     They  are  as  under  : — 

Gout. — A  single  bath  is  often  sufficient  to  cause  a  very 
considerable  alleviation  of  pain  in  cases  of  acute  gout.  The 
sedative  effect  usually  begins  to  be  felt  at  a  temperature 
of  about  171°  C.  and  continues  for  several  hours  after  the 
bath,  which  usually  lasts  for  from  thirty  to  forty-five 
minutes.  When  the  pain  returns,  it  is  always  less  severe. 
Douglas  Kerr  usually  prescribed  a  Dowsing  complete  bath  in 
the  morning,  and  a  local  application  at  mid-day.  The  dur- 
ation of  the  severest  attacks  is  then  reduced  to  a  few  days. 

Immediately  after  the  commencement  of  the  treatment 
it  is  noticeable  that  the  urine  becomes  more  abundant, 
and  richer  in  urea,  urates,  and  uric  acid. 

In  cases  of  subacute  or  chronic  gout,  not  only  is  there 
alleviation  of  pain,  but  often  the  deformities  of  the  joints, 
so  characteristic  of  this  affection,  become  less  pronounced, 
and  even  disappear  entirely,  while  the  improvement  in 
the  functions  of  elimination  has  a  rapid  and  favourable 
influence  on  the  general  health  of  the  patient. 

Rheumatism. — In  a  case  of  polyarthritic  febrile 
rheumatism,  where  salicylates  and  antipyrin  did  not  seem 
to  give  very  appreciable  results,  a  Dowsing  bath  of  150°  C, 
lasting  on  an  average  about  twenty  minutes,  was  given 
daily.'  There  was  an  almost  immediate  alleviation  of 
pain,  the  sw-elling  decreased,  the  temperature  was  lowered, 
and  the  volume  of  urine  augmented.  The  illness  lasted 
for  a  period  of  twelve  days,  but  the  pain  was  very 
considerably  diminished  from  the  time  of  the  lirst 
application  of  the  luminous  radiant  heat,  and  convalescence 
resulted  without  any  complications.  It  is,  of  course,  not 
possible  to  draw  conclusions  from  any  single  observation, 
but  the  results  in  this  case  were  such  as  to  justif}^ 
recourse  to  similar  treatment  under  like  conditions. 


108  NATURAL     THERAPY 

In  the  different  forms  of  rheumatism — chronic,  articular, 
muscular,  blennorrhagic,  and  senile  arthritis — the  sedative 
action  of  the  luminous  radiant  heat  in  the  alleviation  of 
pain  is  very  marked,  while  the  inability  to  move  the  affected 
limb  gradually  disappears. 

Bruises,  Sprains,  etc. — In  the  treatment  of  these 
affections,  luminous  radiant  heat  has  proved  of  signal 
service,  especially  for  football  players,  by  whom  it  has 
been  extensively  and  most  successfully  used. 

Phlebitis. — In  cases  of  phlebitis,  even  where  the 
oedematous  swelling  is  at  a  chronic  stage,  radiant  heat 
treatment  is  excellent.  After  a  single  bath  there  is  a 
marked  reduction  in  the  size  of  the  part  affected,  while 
continued  applications  result  in  the  normal  condition 
being  restored. 

Rheumatoid  Arthritis. — According  to  Kerr,  at  the 
initial  stage,  even  at  the  time  when  the  attacks  are  most 
acute,  there  is  a  rapid  improvement  in  the  flexibility  of 
the  joints  and  in  the  general  condition  of  the  patient,  who 
not  infrequently  gains  in  weight  during  the  course  of  treat- 
ment. At  a  more  advanced  period,  when  the  joints  have 
become  deformed  and  there  is  a  cessation  of  pain,  the 
application  of  luminous  radiant  heat  is  of  itself  ineffectual, 
but  if  the  adhesions  are  broken,  either  gradually  or  suddenly, 
and  a  Kiss  bath  taken  immediately  thereafter,  the  result 
is  a  considerable  diminution  of  the  deformity,  and,  after  sub- 
sequent baths,  some  recovery  of  the  flexibility  of  the  joints. 

Sciatica. — In  sciatica  the  results  are  often  at  variance 
with  one  another.  All  experience  a  considerable  amount 
of  relief  during  the  bath  ;  some  are  quickly  cured,  while 
others,  on  the  contrary,  have  a  recurrence  of  sharp 
and  acute  pain.  These  differences  are  probably  to  be 
accounted  for  by  insufficient  diagnosis  ;  for  instance, 
it  is  known  that,  whatever  be  the  form  of  treatment,  the 
same  results  are  not  obtained  in  cases  of  neuralgic  as  in 
those  of  neuritic  sciatica. 

Nephritis. — The  utility  of  the  radiant-heat  bath  in  cases 
of  nephritis  consists  in  the  profuse  perspiration  which  it 
induces,  thus  relieving  the  work  of  the  kidneys. 

General  Affections,  such  as  obesity,  anaemia,  general 
debility,  and  predisposition  to  rheumatic  affections,  are  all 


THERMOTHERAPY  109 

beneficially  influenced  by  the  action  of  luminous  radiant 
heat  on  the  functions  of  nutrition,  respiration,  and 
perspiration.  It  has  also  been  shown  that  the  luminous 
rays  increase  the  number  of  the  red  corpuscles  in  the  blood 
and  their  power  of  oxygenation. 

Summary. 

The  physiological  action  of  the  radiant-heat  bath  may 
be  brieliy  summarized  thus  : — 

1.  Very  marked  redness  of  the  skin. 

2.  Very  abundant  perspiration  and  the  elimination  of 
considerable  quantities  of  carbonic  acid  by  the  lungs. 

3.  x\cceleration  of  the  pulse  and  increase  of  temperature 
— these  two  phenomena  are  less  marked  in  proportion 
than  in  the  Turkish  bath. 

4.  Increase  of  the  volume  of  solid  materials  of  the  urine, 
especially  of  the  urea  and  uric  acid. 

5.  Greater  activity  of  the  functions  of  general  nutrition, 
and  the  elimination  of  organic  oxidation  products. 

6.  Penetrating  power  of  the  heat  rays  much  greater 
than  that  of  obscure  heat. 

7.  Marked  excitation  of  the  skin  by  the  chemical  rays, 
which  possess  pronounced  bactericidal  properties. 

8.  Special  action  of  the  luminous  rays  on  the  red  corpuscles 
of  the  blood,  augmenting  their  number  and  thus  increasing 
their  power  of  oxygenation. 

The  Dowsing  Radiant-Heat  Baths. — In  1896,  H.  J. 
Dowsing,  an  electrical  engineer,  invented  an  apparatus 
which  transformed  electricity  in  vacuo  into  radiant  heat. 

Special  electric  lamps  constituted  the  source  of  luminous 
radiant  heat.  The  electric  lamp  is  formed  of  a  filament 
contained  in  vacuo,  within  specially  prepared  glass  bulbs, 
or  tubes  of  various  shapes,  according  to  requirements. 
They  are  equally  suitable  for  either  continuous  or  alter- 
nating currents,  and  for  any  voltage.  Instead  of,  as  in 
ordinary  lamps  used  for  lighting  purposes,  producing  light 
without  appreciable  heat,  powerful  heat  rays  as  well  as 
light  rays  are  emitted.  The  heat  rays  are  of  such  intensity' 
that  a  thermometer  placed  between  two  lamps  provided 
with  reflectors,  and  separated  by  a  distance  of  some  sixteen 


110 


NATURAL     THERAPY 


inches,  registers  almost  immediately  about  204°  C.  The 
electric  current,  before  reaching  the  lamps,  passes  through 
a  variable  resistance,  which  serves  as  a  regulator,  by 
means  of  which  any  desired  temperature  may  be  obtained. 
The  lamps  are  fixed  in  highly  burnished  reflectors  of 
suitable  formation,  and  are  easily  adjustable  to  any  position 
necessary  to  direct  the  luminous  radiant-heat  rays  either 
on  any  desired  part,  or  on  the  whole,  of  the  body  {See 
Fig.  44  and  Plate  XIX).  The  curve  of  the  surface  of 
reflection  must  be  such  that  the  heat  rays  emanating  from 
the  lamps  are  prevented  from  striking  against  the  glass ; 


Fig.  44. — Dowsing  L,uminous-heat   Apparatus. 

otherwise,  owing  to   the  very  high  temperature  obtained, 
the  lamp  might  be  injured. 

The  appliances  thus  permit  of  the  application  of  luminous 
radiant  heat  as  already  mentioned  : — 

(a)  By  direct  radiation  without  heating  the  surrounding 

air. 

(b)  By    diffusion    in    an    enclosed    space,    automatically 

ventilated,  thus    heating    the    air    within    such    en- 
closed space. 

(c)  By  the  utilization  of  certain  determined  radiations 

to  the  exclusion  of  others. 


THERMOTHER  AP  Y  1 1 1 

Appliances  for  Direct  Radiation  without  Heating  the 
Surrounding  Atmosphere. — One  or  more  Dowsing  lamps  are 
mounted  with  reflectors,  which,  by  the  diversity  of  their 
forms,  permit  of  the  hmitation  of  their  radiation  activity 
to  certain  parts  of  the  body,  to  more  or  less  extended 
portions,  or  to  the  whole  of  the  body. 

The  reflectors,  mounted  on  a  vertical  and  movable  stand, 
can  be  fixed  at  different  heights.  One  can  thus  easity  direct 
the  luminous  radiant-heat  rays  on  an}^  part  of  the  body  of  a 
patient,  sitting,  standing,  or  reclining  {Fig.  45).  There  being 
nothing  in  the  nature  of  an  enclosure,  and  the  temperature 
of  the  room  being  in  no  way  raised,  the  patient  breathes 


Fig.  45. — Direct  Radiator  applied  to  Back  of  the  Neck. 

the  normal  atmosphere — a  point  of  no  inconsiderable  advan- 
tage. This  method  of  treatment  is  comparable  to  a  sun 
bath,  with  the  added  convenience  that,  by  means  of  a 
rheostat  attached  to  the  appliance,  the  intensity  of  the  heat 
can  be  increased  or  decreased  as  may  be  required  or  desired. 
The  Leucodescent  Therapeutic  Lamp. — This  is  one  of 
the  best  and  most  powerful  appliances  for  the  administra- 
tion of  radiant  heat  at  present  available.  It  consists  of 
a  high  electric-power  lamp  (300  to  500  c.p.)  placed  within 
a  cylindro-conical  metal  hood.  This  hood  is  lined  with  a 
highly  polished  nickel-plated  smia.ce— the  reflector.     The  top 


112  NATURAL     THERAPY 

of  this  dome-like  hood  is  formed  by  a  corrugated  aluminium 
plate,  which  is  called  the  condenser.  This  does  not  become 
tarnished,  because  aluminium  is  not  affected  by  ordinary 
corrosive  substances. 

The  nickel -plated  reflector,  however,  especially  the 
conical  portion,  which  is  of  such  great  importance  in 
crossing  and  recrossing  the  millions  of  light  rays,  must  be 
kept  bright.  This  is  absolutely  essential  if  the  full  power 
of  the  lamp  is  to  be  maintained,  and  is  easily  effected  by 
the  regular  application  of  a  little  plate  powder  on  a  chamois 
leather.  The  incandescent  lamp  is  kept  in  its  position  by 
means  of  two  binding  posts  connected  by  suitable  wires 
with  the  main. 

Attached  to  one  side  of  the  hood  is  a  wooden  handle 
for  manipulating  the  apparatus.  By  means  of  this  the 
lamp  may  be  readily  swung  to  and  fro,  as  it  is  carefully 
balanced  by  a  special  mechanism.  On  the  side  opposite 
the  handle  is  a  circular  window  in  the  hood  through 
which  the  operator  may  view  the  surface  under  treatment. 
The  rays  obtained  from  this  lamp  are  to  all  intents  and 
purposes  intensified  sunlight,  combining  all  the  physical 
properties  of  light  and  heat. 

Appliances  for  Diffusion  of  Luminous  Radiant  Heat 
in  an  Enclosed  Space. — The  lamps,  fitted  with  special 
reflectors,  are  fixed  in  an  enclosed  space,  varying  in 
size  and  arrangement,  according  as  the  treatment  is  required 
for  only  a  part,  or  for  the  whole,  of  the  body  {Fig.  46). 
It  must  not  be  understood  by  the  term  "  enclosed  space  "  as 
here  used  that  the  circulation  of  the  outer  air  is  completely 
suppressed.  Perfect  ventilation  is  necessary,  and  is  secured, 
in  order  to  eliminate  as  much  as  possible,  and  as  soon  as 
formed,  the  perspiration  from  the  body  brought  about  by 
the  very  high  temperature  to  which  the  patient  is  subj  ected  ; 
the  automatic  ventilation  provided  in  the  Dowsing  apparatus 
is  amply  sufficient  to  keep  the  patient's  skin  perfectly  dry. 

There  are  also  appliances  for  administering  the  heat 
by  direct  radiation  without  raising  the  temperature  of  the 
atmosphere  surrounding  the  body. 

The  complete  body  bath  consists  of  a  bed  fitted  with 
asbestos-lined  mattress  and  blanket,  and  having  five 
reflectors,  each  containing  two  Dowsing  lamps,  with  rheostat 


THERMOTHERAPY 


113 


for  regulating  the  current.  The  reflectors  are  fixed  on 
metal  rods,  easily  movable,  supported  by  standards 
resting  on  the  floor  or  fixed  to  the  sides  of  the  bedstead. 
The  patient,  being  undressed,  lays  himself  upon  the  mattress, 
and  is  covered  with  the  asbestos-lined  blanket,  and  the 
head  only  being  exposed,  the  patient  breathes  the  normal 
atmosphere  of  the  room.  The  current  is  then  turned  on, 
and  by  means  of  the  rheostat,  the  air  within  the  enclosed 
space  is  brought  up  to  the  requisite  temperature.  The 
local  baths  for  the  various  limbs  are,  of  course,  on  a 
smaller  scale,  and  are  made  of  special  shapes  for  treating 
deformed  limbs,   etc.     The  apparatus  for  the  leg  or  foot 


Fig.  46. — Local  Radiant-heat  Cabinet. 

can  be  placed  on  a  stand  of  suitable  height,  while  that  for 
the  upper  limbs  is  fixed  on  a  stand  which  can  be  adjusted 
in  any  direction. 

In  all  local  baths,  when  using  the  asbestos-lined  blanket, 
tlie  luminous  radiant  heat  acts,  not  only  by  radiation,  but 
also  by  superheating  the  air  in  the  enclosed  space ;  other- 
wise the  radiation  is  direct,  without  in  any  way  affecting 
the  temperature  of  the  surrounding  atmosphere. 

For  all  local  applications  other  than  of  the  limbs,  the 
apparatus  or  appliance  consists  of  a  lamp  and  reflector 
attached  to  a  movable  stand,  the  arrangement  of  which 
is  such  that,  by  means  of  swivels  and  ball-and-socket  joints, 
the  reflectors  may  be  moved  and  the  rays  readily  directed 
on  any  part  of  the  body. 

8 


114  NATURAL     THERAPY 

Appliances  for  the  Utilization  of  Certain  Determined 
Radiations  to  the  Exclusion  of  Others. — For  this  purpose 
a  contrivance  in  the  nature  of  a  highly  burnished 
metallic  cone  is  used,  within  which  is  placed  a  Dowsing 
lamp  so  arranged  that  the  rays  are  concentrated  at  the 
apex,  where  screens  of  various  colours  can  be  fixed  to  allow 
the  modified  rays  to  pass.  A  red  glass  screen  stops  the 
chemical  rays,  and  an  alum  solution  cuts  off  the  heat  rays. 
A  solution  of  sulphate  of  copper  held  between  two  crystal 
glass  plates  will  allow  chemical  rays  only  to  pass.  This 
is  a  feature  in  therapeutics  which  is  still  in  its  infancy, 
and  it  is  well  worth  the  attention  of  medical  men.  The 
remarkable  results  obtained  by  the  late  N.  R.  Finsen,  of 
Copenhagen,  tend  to  show  that  much  may  yet  be  expected 
from  it. 

The  Greville  Electro-thermic  Generators. — These  appar- 
atus are  usually  made  of  aluminium,  and  are  designed  for 
treatment  of  the  whole  body  (with  the  exclusion  of  the 
head),  or  any  region  in  particular  {Plate  XX)  ;  indeed,  one 
of  the  main  features  of  the  system  is  the  ease  with  which 
heat  may  be  applied  to  any  portion  of  the  body  affected. 
The  heat  is  produced  by  the  flow  of  electricity  through 
sections  of  naked  wire  made  of  a  non-oxidizable  metal 
or  compound  of  metals.  The  wires  (arranged  like  harp 
strings)  are  wound  upon  porcelain  insulators  attached 
to  the  back  of  the  generator,  while  the  front  or  inner  side 
is  of  perforated  sheet  aluminium.  A  temperature  of  200°- 
250°  C^  is  easily  obtainable,  and  is  under  absolute  control. 
The  electric  current  may  be  taken  from  the  ordinary 
lighting  mains  or  from  accumulators. 

In  this  system  the  rays  convected  from  the  naked  wires 
are  of  heat-giving  properties  only.  In  fact,  the  main 
difference  between  the  Greville  and  the  Dowsing  radiant- 
heat  baths  is  that  in  the  former  the  invisible  rays  beyond 
the  red  in  the  spectrum  are  alone  used,  while  in  the  latter 
the  light  rays  are  used.  These  ultra-red  rays  have  been 
found  to  contain  the  maximum  amount  of  heat,  and  no 
injurious  chemical  rays  are  permitted  to  enter  the  generator. 


PL  A  TE     XIX. 


Shoulder   and    Foot   TreatiMent    by    Greville    Generator. 


Greville   Generator   for   One   Arm  in   use. 


PLA  TE     XX. 


(iKl.\  llAA:     (ikM'.RAlOK      I'UR      Hli'     IN      L'hlJ. 


.-«► 


^«^«^«^iaiyiiii^>  -^ 


(iKI.  VILLI',     (jI'.NI'.K  Al  OK      I'Ok      WllOLI':      lioDV      IN      USE. 


115 


CHAPTER    VIII . 


HOT-AIR,    STEAM,    AND    TURKISH 
BATHS. 


THE    HOT-AIR    CABINET    BATH. 

npHE  essential  difference  between  this  and  the  Turkish 
-*-       bath  is  that  the  head  is  excluded  from  contact  with 
the  hot  air,  so  that  the  whole  body  is  exposed  to  dry  super- 
heated air,  while  the  patient  breathes  in  a  comparatively 


Fig.  47. — Hot-air  Cabinet,  heated  bj-  Electrical  resistance  wires. 

cool  atmosphere.  IMany  portable  and  inexpensive  forms  ol 
the  bath  are  sold,  made  of  waterproof  cloth  stretched  on 
a  ^vooden  or  metal  frame,  and  these  are  often  perfectly 
efficacious.  There  are  also  more  elaborate  wooden  cabinets 
constructed,  lined  with  zinc  or  cork  {Fig.  47). 


116  NATURAL     THERAPY 

Electricit}'  is  the  most  suitable  means  to  heat  the  air, 
because  the  temperature  is  easily  under  control,  and  can 
be  increased  up  to  about  150°  C.  (the  exact  amount  can 
be  read  off  on  a  thermometer).  The  air  is  quite  dry, 
and  not  vitiated  by  any  vapours  of  burning  gas  or  oil,  and 
the  patient  breathes  air  of  ordinary  temperature. 

The  heat  is  generated  by  the  electric  current  passing 
through  suitable  resistance  wires,  which  are  wound  over 
porcelain  frames  so  that  the  air  has  free  access.  A  smaller 
or  greater  number  of  these  electric  stoves  can  be  switched 
on  to  regulate  the  temperature. 

The  cabinets  are  made  either  for  the  whole  body  or 
only  for  an  arm  or  leg.  Other  sources  of  heat  employed 
are  small  gas  stoves,  spirit  lamps,  steam  coils,  or  paraftin 
stoves.  Some  of  these  are  not  free  from  risk,  and  more 
than  one  patient  has  been  severely  burnt.  The  electric 
method  or  the  steam  coil  is  certamly  the  best.  If 
a  lamp  or  stove  be  used,  it  must  be  lighted  before  the 
patient  enters  the  bath.  The  bath  may  be  administered 
to  a  patient  in  bed,  by  using  a  special  frame  and  covering, 
under  which  a  tin  pipe  is  led  to  conduct  the  hot  air.  This 
is  a  common  hospital  device. 

The  temperature  of  the  bath  should  vary  from  65°  C.  to 
120°  C,  and  the  duration  may  be  from  six  minutes  to  one 
hour,  according  to  circumstances.  The  maximum  beneficial 
effects  can  be  obtained  in  the  generality  of  cases  in  thirty 
to  forty  minutes. 

Before  entering  the  bath,  the  patient  should  remove  all 
his  clothing,  and  wrap  up  in  a  blanket  or  large  Turkey  bath 
sheet  while  waiting.  Before  and  during  the  bath,  water, 
hot  or  cold,  should  be  freely  drunk.  The  head  should  be 
enveloped  in  a  cool,  damp  cloth. 

On  leaving  the  bath,  the  patient  is  given  a  spray  or  rain 
douche,  and  if  necessary  a  vigorous  reaction  insured  by 
friction.  In  rheumatic  cases  it  is  sometimes  well  to  prolong 
the  perspiration  in  a  gentle  form  by  enveloping  the  patient 
with  warm  blankets,  and  merely  finish  off  with  a  cool 
sponging. 

Therapeutic  Indications. 

Hot  air  is  of  great  value  in  the  treatment  of  obesity,  uric 
acid  diathesis,  fatty  glycosurics,  neurasthenia,  or  indeed  any 


THE     STEAM     CABINET     BATH 


117 


auto-intoxication.  Many  organic  forms  of  chronic  nervous 
disease,  as  locomotor  ataxia,  are  materially  benefited  by 
the  use  of  hot-air  baths,  even  though  we  admit  that  cure 
is  out  of  the  question.  Various  anaemias  also  are  helped, 
care  being  taken  not  to  employ  too  high  a  temperature 
or  unduly  prolong  the  bath. 

All  morbid  conditions  dependent  on  congestion  of  the 
various  internal  organs  are  improved  by  judicious  employ- 
ment of  this  bath.  In  actual  hyperpiesis  particular  care 
is  necessary  in  prescribing  it,  however,  and  the  head  should 
be  invariably  kept  cool  by  means  of  an  ice  bag  or  towel 
wrung  out  of  ice-cold  water. 

THE    STEAM    CABINET    BATH. 

This  is  identical  with  the  Russian  vapour  bath,  except 
that,  instead  of  being  shut  in  a  room  into  which  the  steam 
is  introduced,  the  patient  sits  in  a  cabinet  with  his  head 
excluded  {Fig.  48). 


-The  Steam   Cabinet. 


The  cabinet,  usually  made  of  wood,  should  be  practicallv 
steam-tight.  The  steam  may  be  generated  in  the  cabinet 
itself  or,  which  is  better,  conveyed  from  an  outside 
source. 

The  patient  may  be  vertical  or  horizontal,  and  sits 
or  lies  on  a  latticed  wooden  seat,  under  which  run  pipes 


118  NATURAL     THERAPY 

with  small  perforations  by  means  of  which  the  steam  enters. 
The  temperature  of  the  bath  rises  in  direct  proportion  to 
the  rapidity  with  which  the  steam  enters.  The  temperature 
desirable  is  from  50°  to  55°  C.  The  patient  can  tolerate 
higher  temperatures  after  a  series  of  baths.  No  sensation 
of  burning  is  experienced  when  once  free  diaphoresis  has 
been  established.  As  in  all  such  procedures,  the  head 
of  the  patient  must  be  enveloped  in  a  damp  towel. 
Diaphoresis  is  hastened  and  increased  if  water  be  freely 
drunk. 

On  leaving  the  cabinet,  the  patient  should  have  a  spray 
or  rain  bath,  beginning  with  water  at  30°  C.  and  cooling 
down  to  15°  or  12°  C. 

Duration  of  the  Bath. — On  the  average  from  fifteen  to 
thirty  minutes.  Brief  exposures  of  two  to  five  minutes 
are  employed  as  a  preliminary  to  a  Turkish  bath  or  cold 
stimulating  applications.  Baths  of  over  thirty  minutes' 
duration  should  not  be  employed  except  in  the  case  of  very 
robust  patients. 

Physiological  Effects. — After  a  short  application  the 
cutaneous  vessels  become  dilated  and  the  body  surface 
warm.  In  five  or  six  minutes  perspiration  begins,  and 
the  skin  reddens.  The  body  temperature  rises,  respiration 
and  pulse  are  accelerated,  and  metabolism  is  increased.  The 
white  blood  corpuscles  are  almost  always  increased,  but 
the  red  diminish,  unless  a  relative  increase  takes  place 
owing  to  inspiration  of  blood  from  much  fluid  loss.  There 
is  loss  of  body- weight,  varying  with  the  duration  of 
exposure,  and  often  amounting  to  several  pounds. 

Therapeutic   Indications. 

Brief  baths  are  employed  in  anaemia  and  neurasthenia, 
while  more  prolonged  baths  are  of  service  in  various  constitu- 
tional dyscrasia,  in  rheumatic  affections,  uric  acid  diathesis, 
chronic  renal  disease,  and  in  various  skin  affections,  such  as 
psoriasis.  In  common  colds,  chills,  and  febrile  affections,  the 
diaphoresis  induced  is  also  useful. 

Generally  speaking,  febrile  diseases  are  a  counter- 
indication,  as  are  also  organic  nervous  diseases  (if  we  exclude 
some  of  the  parasyphihdes  at  an  early  stage,  and  chronic 
arterial  degeneration). 


THE     TURKISH     BATH  119 


THE    TURKISH     BATH. 

The  Turkish  bath  is  a  very  ancient  procedure,  and 
dates  from  the  time  of  the  Roman  Empire.  To-day,  in 
various  parts  of  Italy,  in  Rome  and  elsewhere,  the  ruins 
of  such  baths,  used  in  the  time  of  Nero,  may  be  seen.  In 
Jerusalem  a  bath  of  this  nature,  built  at  the  time  of  Herod 
is  still  used  regularly,  after  nearly  two  thousand  years 
have  elapsed.  Practically  every  nation  and  country  has 
some  peculiar  form  of  a  "  sweating  bath,"  some  of  which 
are  extremely  dirty  and  unpleasant.  Probably  the  Turkish 
bath  is  the  most  elaborate  and  luxurious  type  of  this  variety 
of  bath.  In  the  modern  form  it  consists  of  a  series  of 
rooms  comprising  at  least  the  following  compartments  : — 

1.  The  TepidarUun — a  room  heated  to  a  temperature 
of  44°  to  54°  C. 

2.  The  Calidarium — a  room  heated  to  a  temperature  of 
65°  to  93°  C.  In  some  cases  there  is  an  annexe  to  this 
apartment  heated  up  to  120°  to  150°  C,  but  in  smaller 
suites  this  is  usually  dispensed  with  {Plate  XXI). 

3.  The  Shampoo  Room,  which  is  furnished  with  marble 
slab,  douche  apparatus,  etc.,  and  attached  to  this  room 
is  frequently  found  a  plunge  or  swimming  bath  at  a 
temperature  of  12°  to  15°  C.  for  the  more  vigorous  patients 
to  use  as  a  final  measure  in  cooling. 

4.  The  Cooling  and  Dressing  Room,  with  suitable  couches 
for  patients  to  rest  on  from  forty  minutes  to  one  hour  after 
a  bath  [Plate  XXII). 

The  rooms  are  heated  by  means  of  a  furnace,  or 
indirectly  by  a  steam  heater.  Ample  provision  must  be 
made  for  ventilation,  for  inefficiency  in  this  respect  will 
cause  much  oppression  and  headache  to  those  using  the 
bath.  The  outlet  for  foul  air  should  be  near  the  bottom 
of  the  room,  communicating  with  a  ventilating  shaft.  If 
heated  by  hot  air,  the  opening  for  its  admission  is  best 
placed  at  a  point  two  or  three  feet  above  the  level  of  the 
floor. 

Technique. — The  patient,  having  removed  all  his  clothing 
with  the  exception  of  the  loin  cloth  demanded  by  modesty, 
drinks  a  glass  of  water  and  lies  down  on  a  couch  in  the 
tepidarium.     A  moist  cloth  is  often  placed  around  the  head. 


120  NATURAL     THERAPY 

The  time  which  elapses  before  the  onset  of  perspiration 
varies  greatly  in  different  subjects,  but,  on  an  average, 
some  moisture  appears  on  the  skin  in  from  lo  to  15  minutes, 
and  very  soon  the  patient  is  perspiring  profusely.  When 
perspiration  is  slow,  the  activity  of  the  skin  is  increased 
by  the  brisk  application  of  friction  gloves. 

Two  or  three  minutes  spent  in  the  Russian  bath  or  steam- 
box  prior  to  entering  the  Turkish,  soften  the  skin  and 
facilitate  a  good  sweat.  The  feet  may  further  be  placed 
in  a  hot  foot-bath  and  hot  water  freely  imbibed.  Such 
patients  as  do  not  perspire  even  with  these  adjuvants 
usually  experience  a  good  deal  of  oppression  and  discomfort  ; 
the  skin  becomes  very  dry  and  hot,  and  they  should  be 
removed  from  the  bath,  or  they  may  become  seriously 
upset.     These  cases,  however,  are  the  exception. 

Perspiration  having  been  properly  established,  the 
calidarium  or  second  room  may  be  entered,  and  profuse 
perspiration  allowed  for  about  ten  minutes.  Many  people 
are  unable  to  stand  the  intense  heat  of  the  third  room  even 
for  a  few  minutes,  but  hardened  veterans  enjoy  it. 

A  suitable  amount  of  diaphoresis  having  taken  place, 
the  patient  enters  the  shampoo  room  and  lies  down  on 
the  slab.  He  is  briskly  massaged  from  head  to  foot,  much 
superficial  epidermis,  already  loosened  by  the  perspiration, 
being  thus  removed.  Lathering  follows,  hot  soapsuds  being 
ladled  on  to  the  skin  and  well  rubbed  in  with  a  loofah, 
preferably  brought  by  the  patient,  so  as  to  avoid  the 
possibility  of  infection.  The  shampooing  is  a  most  comfort- 
ing process,  and  is  continued  until  the  skin  feels  smooth 
and  polished.  A  douche  or  spray  douche,  from  25°  C.  down 
to  15°  C,  or  even  lower,  is  now  applied.  This  has  a  tonic 
effect,  and  also  serves  to  completely  remove  the  soapsuds. 
The  plunge  bath  may  be  taken  or  omitted,  according  to 
circumstances,  and  then  the  patient,  wrapped  in  a 
warm  sheet,  lies  down  in  the  cooling  room  until  the  pulse 
is  normal  and  the  skin  thoroughly  dry.  A  cup  of  coffee 
at  this  stage  is  beneficial  and  refreshing  in  many  cases. 

Where  the  object  is  reduction  of  weight,  a  daily  Turkish 
bath  up  to  one  hour  in  duration  may  be  employed,  but 
for  the  average  person  three  a  week  are  amply  sufficient, 
and  with  feeble  patients  these  must  be  of  brief  duration. 


THE     TURKISH     BATH  121 

Physiological  Action. — The  sweat-glands  are  powerfully 
stimulated,  and  the  amount  of  secretion  may  rise  from 
the  normal  i-}  oz.  per  hour  to  several  pounds  per  hour. 
A  loss  of  2  lbs.  in  weight  is  quite  common  after  a  full  Turkish 
bath.  Unless  the  patient  drink  water  freely,  the  blood 
volume  will  be  considerably  reduced  in  these  circumstances, 
and  cardiac  enfeeblement  result.  Blood  is  withdrawn 
from  liver,  spleen,  and  all  the  internal  organs,  and  the 
absorption  of  fluid  from  the  intestines  which  takes  place 
leads  to  subsequent  constipation  in  some  cases. 

By  the  inhalation  of  the  hot  air,  the  pulmonar^^  mucous 
membrane  is  excited  to  secretion  to  some  extent,  rapid 
volatilization  occurring.     The  respiration  is  mainly  thoracic. 

The  cardiac  beats  quicken  and  the  mean  blood-pressure 
rises  soon  after  the  bath  is  entered,  and  some  fullness  in 
the  head  and  discomfort  may  be  experienced,  lessened  by 
the  foot-bath  mentioned  above.  The  mean  blood-pressure 
falls  and  the  pulse  slows  with  the  onset  of  perspiration.  The 
rise  in  body-temperature  is  so  slight  as  to  be  negligible 
in  the  majority  of  cases.  In  very  obese  persons  this  may 
not  be  the  case,  however,  as  the  heat  loss  in  such  cases  is 
not  proportionate  to  the  heat  gain.  Kellogg  points  out 
that  such  patients  have  much  smaller  skin  surface  in 
proportion  to  their  weight  than  spare  individuals. 

Therapeutic  Indications. 

These  are  practically  the  same  as  the  hot-air  bath, 
but  the  Turkish  bath  cannot  be  employed  for  many  cases 
for  which  the  hot-air  bath  is  quite  advisable.  It  is  contra- 
indicated,  e.g.,  in  arteriosclerotic  conditions,  cardiac  asthma 
and  dilatation,  exophthalmic  goitre,  in  patients  with 
unusually  high  blood-pressure,  and  in  advanced  renal 
disease. 


122 


CHAPTER     IX. 
PHOTOTHERAPY. 

TT  has  been  shown  that  sunhght  is  made  up  of  various 
kinds  of  rays,  and  the  existence  of  the  following  have 
been  clearly  demonstrated:  (i)  Heat  rays  ;  (2)  Light  rays; 
(3)  Chemical  or  actinic  rays. 

The  heat  rays,  although  invisible,  make  a  powerful 
impression  on  the  cutaneous  nerves.  They  are  found  in 
the  red  portion  of  the  spectrum  ;  while  the  light  rays  are 
in  the  yellow  portion,  and  the  chemical  rays  in  the  violet 
and  ultra-violet  portions.  Chemical  rays  are  invisible, 
but  act  on  the  skin.  By  various  devices  any  of  these 
elements  in  a  sunlight  ray  may  be  picked  out  or  eliminated. 

The  electric  arc  light  and  sunlight  are  very  similar,  the 
former  containing  more  actinic  or  chemical  rays  in  beams 
of  equal  luminosity.  The  incandescent  light  contains  a 
large  portion  of  heat  rays.  The  effects  of  exposure  to  light 
are  due  chiefly  to  the  action  of  the  chemical  and  thermal 
rays.  The  powerful  effect  of  light  on  plant  life  is  shown 
by  the  manner  in  which  plants,  leaves,  or  flower-stalks  bend 
towards  the  origin  of  the  light  in  their  growth.  Light 
rays  are  powerful  for  good  or  ill,  however,  and  as  is  well 
known,  concentrated  sunlight  will  scorch  and  destroy 
plant  life. 

On  animal  life  the  action  of  the  chemical  rays  is  well 
demonstrated  in  sun-burn  in  man,  and  the  darkening  of 
the  white  coat  of  animals  long  exposed  to  sunlight.  The 
pigment  in  the  skin  of  races  resident  in  tropical  zones  is 
largely  a  protective  measure. 

Action  of  Light  on  Metabolic  Processes. — The  output 
of  CO2  is  increased  in  all  animals  when  exposed  to  light  ; 
all  tissue  changes  are  more  rapid,  and  if  food  be  withheld 
more  weight  is  lost  in  daylight  than  in  the  dark.  The 
metabolic  processes  of  prisoners  coniined  in  solitary, 
darkened  cells,  fed  on  a  scanty  supply  of  bread  and  water, 


PHOTOTHERAPY  123 

are  sluggish  in  the  extreme,  with  resultant  mental  depression 
and  sense  of  humiliation.  This  also  has  much  to  do  with 
the  occurrence  of  cretinism  in  the  deep,  sunless  valleys 
of  Switzerland. 

Tissue  oxidation  is  unquestionably  increased  by  sunlight 
in  all  living  creatures,  and  in  the  human  species  this  is  due 
to  reflexes  set  up  by  the  stimulation  by  light  rays  of  the 
nerve  endings  in  the  skin. 

Exposure  to  powerful  sunlight  causes  headache  and 
vertigo,  due  to  too  powerful  stimulation  of  the  optic  nerve  ; 
similar  results  are  seen  after  prolonged  exposure  of  the 
naked  trunk.  Black  races  are  protected  against  the  actinic 
or  chemical  rays  by  the  pigment  in  their  skin,  which  is 
impenetrable  to  these  rays,  and  a  white  man  can  acquire 
temporary  immunity  similarly  by  the  application  of  some 
black  water-paint. 

Sunstroke  is  of  course  due  to  over-exposure  of  the  central 
nervous  system,  head  or  neck  being  insufficiently  covered, 
to  strong  sunlight.  In  Europeans,  a  very  brief  exposure 
suffices,  but  in  the  native  races  some  immunity  is  acquired 
by  the  nervous  system  becoming  so  far  habituated  to  the 
special  stimulus.  In  India  it  is  not  uncommon,  even  at 
noon,  to  see  natives  stretched  on  the  ground  asleep, 
absolutely  unprotected  against  a  scorching  sun. 

The  functions  of  the  skin  are  all  stimulated  by  such 
exposure  to  the  sun's  rays,  irrespective,  to  some  extent, 
of  the  temperature  of  the  surrounding  air.  Profuse 
perspiration  is  induced  by  the  action  of  the  chemical  and 
the  heat  rays,  the  latter  being  most  concerned.  Toxic 
substances  in  the  blood  may  be  thus  got  rid  of,  but  further 
light  has  a  most  powerful  germicidal  inHuence,  rapidly 
killing  parasites,  fungi,  and  several  of  the  more  virulent 
types  of  bacteria. 

Therapeutic  Application  of  Light. — (i)  Sunlight  ;  (2) 
Electric  light :  (a)  arc,  (6)  incandescent.  It  has  been  clearh' 
demonstrated  that  the  nature  of  these  forms  of  light  is  the 
same,  irrespective  of  the  source,  although  the  latter  is  of 
importance  in  considering  the  questions  of  convenience 
in  practical  application  and  the  therapeutic  results. 

Sunlight  contains  all  these  types  of  rays  in  abundance  ; 
of    electric    lights,     the     arc    resembles     it     most.       The 


124  NATURAL     THERAPY 

incandescent  light  contains  about  90  per  cent  of  heat 
rays,  the  balance  being  made  up  of  small  proportions  of 
luminous  and  chemical  rays.  In  this  country  the  use  of 
this  bath  is  largely  restricted  to  the  indoor  form,  owing 
to  the  low  temperatures  prevailing  at  most  seasons  of 
the  year. 

The  only  sanatorium  in  Great  Britain  with  an  open-air 
sun  bath  is  Peebles  Hydropathic  {Plate  XXII 1).  Here,  in 
suitable  weather,  the  more  vigorous  types  of  patients  lie 
out  on  couches,  clad  in  a  waist  towel  only,  for  half  an  hour 
or  more.  They  may  walk  about,  indulge  in  the  health- 
giving  skipping  so  warmly  advocated  by  Dr.  F.  T.  Bond, 
of  Gloucester,  or  use  light  dumb-bells,  and  so  increase 
oxidation  to  as  high  a  degree  as  possible  ;  at  the  same 
time  keeping  comfortably  warm.  Instead  of  couches,  a 
sand-bed  or  bank  is  very  useful,  and  is  employed  at  Battle 
Creek  Sanatorium  {Plate  XXIV).  The  sand  is  always 
warmer  owing  to  the  prolonged  exposure  to  the  sun.  In 
private  houses  a  flat  roof  free  from  observation  from 
higher  altitudes  may  be  utilized,  and  in  many  places  small 
roofless  huts  of  suitable  size  and  altitude. 

The  Indoor  Sun  Bath. — The  indoor  sun  bath  is  often 
more  convenient  in  this  country,  and  can  be  easily  arranged, 
given  a  suitable  south  exposure  and  sufficient  degree  of 
sunlight  {Plate  XXIII). 

Since  the  valuable  ultra-violet  rays  are  absorbed  by 
glass,  it  is  necessary  that  the  windows  in  the  room  used 
open  on  a  hinge,  a  la  Frangaise.  Apart  from  the  head, 
which  should  be  suitably  protected  by  a  moist  towel  or 
wrapping  of  some  sort,  the  greater  the  surface  exposed  to 
the  sunhght  the  better.  But  this  will  depend  on  different 
circumstances,  such  as  the  degrees  of  warmth  and  sunlight, 
and  the  strength  of  the  patient. 

When  localized  applications  are  desired  for  any  special 
affection,  the  parts  of  the  body  not  exposed  should  be 
merely  covered  with  a  white  sheet  or  blanket. 

The  duration  of  the  bath  varies  greatly.  It  will  depend 
on  the  season  of  the  year,  the  climate  in  which  it  is  employed, 
and  the  prevailing  weather  conditions.  At  the  start  three 
minutes  are  often  sufficient  for  a  feeble  patient.  Caution  is 
always  needful,  for  too  long  exposure  will  cause  headache, 


PLA  TE     XXIII. 


Open-Air    Sun    Bath    (Peebles). 


Indoor  Sln   Bath. 


Oh 


PHOTOTHERAPY  125 

lassitude,  and  depression  if  the  sun  be  hot,  and  possibly 
a  severe  chill  or  even  pneumonia  if  the  air  be  cold. 

Individuals  with  dark  hair  and  complexion  are  less 
sensitive  to  the  influence  of  sunlight  than  fair,  blue-eyed 
people,  and  for  the  former  the  exposure  may  often  be  allowed 
for  half  an  hour  or  more  without  harm  resulting.  Custom 
counts  for  a  great  deal,  too,  and  after  the  training  and 
toning  up  afforded  by  a  series  of  baths,  exposure  for  two  or 
three  hours  daily  can  often  be  tolerated  and  enjoyed.  The 
skin  usually  darkens  considerably,  from  increase  in  pigment. 

In  northern  temperate  latitudes,  the  intensity  of  the 
sun's  rays  is  greatest  from  mid- June  to  mid-September, 
and  the  intensity  always  increases  with  the  altitude. 

After-treatment. — x\t  the  conclusion  of  the  bath,  the 
patient  should  be  taken  in  hand  by  an  attendant  and  given 
either  a  wet-sheet  rub  or  a  cooling  spray  or  douche,  or  in 
the  case  of  robust  and  vigorous  patients,  a  plunge  and  short 
swim  is  a  beneficial  termination. 

Temperature  of  the  Patient. — The  patient's  temperature 
should  be  taken  immediately  before,  during,  and  after  the 
sun  bath.     The  temperature  usually  rises  from  -5  to  1°  C. 

In  individuals  who  perspire  freely  the  temperature 
usually  rises  but  slightly,  but  in  persons  with  dry  skins,  such 
as  chronic  dyspeptics,  diabetics,  and  those  suffering  from 
extensive  scleroderma,  a  higher  temperature  is  soon  shown. 

Physiological  Effects. — The  reaction  induced  bv  a  sun  bath 
represents  the  effect  of  the  combined  influence  of  the  ther- 
mic, luminous,  and  chemical  elements  of  the  sun's  rays. 

The  heat  rays  elevate  the  body  temperature  just  as  the 
hot  air  or  steam  do  in  the  hot-air  or  vapour  bath  cabinet, 
either  by  causing  an  accumulation  of  heat  or  preventing 
its  escape  by  radiation  and  evaporation.  All  the  organs 
of  the  body  are  stimulated,  and  the  metabolic  activity  is 
increased.  There  is  increased  oxidation  of  proteid  sub- 
stances, increased  consumption  of  carboh\^drates  and  fats, 
and  increased  output  of  CO,  correspondingly.  The  cu- 
taneous vessels  are  dilated,  the  sweat  glands  rendered 
more  active,  and  the  actual  amount  of  sweat  may  rise 
from  the  normal  average  of  i-\  oz.  per  hour  to  2  or  3  lb., 
particularly  if  the  patient  is  taking  exercise  {vide  supra). 

The  blood  is  markedly  diverted  from  the  internal  organs 


126  NATURAL     THERAPY 

to  the  skin  surface,  and  these  viscera  thus  rendered  anjemic 
pro  tern.  ;  the  patient  is  often  rendered  very  drowsy  by  the 
cerebral  an.'emia.  Finsen  has  further  shown  that  the 
chemical  rays  are  equally  active  as  regards  the  nervous 
system,  and  have  a  markedly  tonic  influence. 

Therapeutic   Indications. 

It  will  be  seen  at  once  that  all  cases  in  which  defective 
metabolism  participates  in  the  cause  of  morbid  conditions 
are,  cceteris  paribus,  a  fair  mark  for  sun  baths.  Among 
the  most  common  of  these  are  dyspepsia,  diabetes,  obesity, 
and  that  congeries  of  symptoms  included  under  the 
phrase  "  uric  acid  diathesis,"  with  which  possibly  uric 
acid  has  very  little  to  do.  In  anaemic  conditions,  the 
ha^mopoietic  centres  are  stimulated,  toxins  are  eliminated, 
and  an  accompanying  and  often  resulting  neurasthenia  is 
relieved.  In  some  forms  of  renal  disease,  hepatic  conges- 
tion, and  early  cirrhosis,  benefit  is  frequently  derived. 
In  tuberculous  conditions  a  noticeable  improvement  is 
also  seen,  when  the  climate  permits  of  the  sun  bath 
forming  part  of  the  open-air  regime  now  so  universally 
employed. 

Even  skin  diseases  such  as  eczema  and  psoriasis  are  found 
to  benefit ;  but  it  will  be  obvious  that  in  such  cases  there 
will  be  objections  to  "  mixed  bathing  "  : 

Caution. — Care  must  be  taken  not  to  unduly  expose 
cardiac  cases,  and  special  precautions  to  keep  the  head 
cool  are  necessary  in  patients  suffering  from  insomnia. 

THE    ELECTRIC-LIGHT    BATH. 

Electric  light  is  possessed  of  properties  identical  with 
those  of  the  sun's  rays.  Both  the  arc  and  the  incandescent 
lights  may  be  employed  for  this  bath  :  in  the  former  the 
luminous   rays  predominate,  in  the  latter  heat  rays. 

In  the  forms  of  electric-light  baths  used  in  the  United 
States  in  the  early  eighties,  a  single  reflector  was  placed 
at  the  back  of  the  bath  to  focus  the  rays  on  the  patient. 

PhYsiological  EfTects- — As  a  result  of  a  series  of  experi- 
ments carried  out  by  him,  Siemens  arrived  at  the  following 
conclusions  : — 


PHOTOTHERAPY 


12: 


1.  Electric  light  has  the  effect  of  producing  chlorophyll 
in  the  leaves  of  plants  and  promoting  growth,  and  of 
favouring  protoplasmic  activity. 

2.  The  action  of  the  artificial  light  is  identical  with  that 
of  daylight. 


Fig.  49. — Vertical  Electric-light  Cabinet. 

3.  Under  the  influence  of  electric  light,  plants  were  able 
to  sustain  increased  stove-heat  without  collapsing,  showing 
the  influence  of  light  as  a  vital  stimulant.  These  observa- 
tions were  confirmed  by  Sarat,  Prillieux,  and  others. 

It  has  been  found  that  bacteria  are  killed  in  a  few  minutes 
by  exposure  to  the  concentrated  rays  of  a  6000  candle- 
power  lamp. 


128  NATURAL     THERAPY 

« 

On  the  skin,  the  apphcation  of  electric  hght  has  the  same 
effect  as  sunhght,  producing  free  perspiration,  pigmentation 
and  erythema. 

The  Incandescent  Electric -light  Bath. — This  is  the 
most  convenient  and  commonly  used  form.  The  most 
elementary  type  consists  of  a  frame  on  which  are  sup- 
ported a  metal  reflector  and  a  large  number  (20  to  30)  of 
lamps.  The  patient  is  laid  or  seated  opposite  to  this,  and 
one  surface  of  the  body  is  exposed  ;  later,  he  is  turned  round 
and  receives  the  application  of  the  light  on  the  opposite  side. 

The  Cabinet  form  (vertical)  of  bath,  as  devised  by 
Winternitz,  is  now  commonly  used  {See  Fig.  49  and  Plate 
XXV).  The  patient  sits  in  the  cabinet  with  his  head 
excluded,  while  the  naked  surface  of  his  body  is  exposed 
to  the  action  of  from  20  to  40  lights  for  a  period  of  from 
fifteen  to  forty  minutes  ;  for  a  merely  tonic  effect  three 
to  ten  minutes  will  suffice.  If  it  is  desired  to  make  the 
skin  act  freely,  so  as  to  have  an  eliminative  or  diaphoretic 
action,  the  patient  is  allowed  to  perspire  freely  for  half 
an  hour  or  more. 

A  disadvantage  of  the  vertical  form  of  cabinet  is  that  the 
patient  has  to  sit  in  a  somewhat  constrained  upright  position. 
This  is  rendered  unnecessarily  uncomfortable  by  the  ten- 
dency of  the  makers  to  put  the  hole  for  the  patient's  head 
absolutel}^  in  the  centre  of  the  bath,  whereas  it  would  be 
better  if  nearer  the  posterior  wall,  with  the  whole  cabinet 
sloped  somewhat  backwards.  For  patients  who  are  delicate 
and  who  have  any  tendency  to  faint,  the  horizontal  cabinet 
{Fig.  50)  is  to  be  preferred,  and  it  is  at  all  times  more 
comfortable. 

Precautions. — The  feet  of  the  patient  should  be  warm — 
if  necessary  by  the  use  of  a  warm  foot-bath — and  head  cool ; 
a  damp  towel  may  be  wrapped  around  it  turban  fashion. 
This  should  be  freshly  immersed  in  cold  water  and  re- 
applied as  often  as  it  becomes  warm. 

The  temperature  of  ike  hath  may  range  from  65°  C  to 
150°  or  even  200°  C.  The  heat  is  applied  to  the  body 
by  means  of  the  radiant  energy  of  the  incandescent  lamps, 
and  not  by  the  air,  through  which  the  hght  passes 
without  heating  it  to  any  great  extent.  It  follows,  there- 
fore, that  the  actual  temperature  of  the  air  surrounding  the 


PLATE     XXV. 


Thi;    Electkic-Light    Bath. 


PHOTOTHERAPY 


129 


patient  is  of  very  little  moment.  The  less  moisture  there 
is  present  in  the  air  contained  in  the  cabinet  the  higher 
will  the  temperature  tolerable  to  the  patient  be.  Good 
ventilation  of  the  bath  is  therefore  essential  in  order  that 
the  moisture  arising  from  the  patient's  body  be  carried  off. 
The  intensity  of  the  bath  is  regulated  by  means  of  switches 
for  increasing  or  lessening  the  number  of  lights,  or  by 
a  rheostat. 

After-treatment. — The  patient,  on  completion  of  the 
application,  is  lathered  down  with  soap-suds  and  douched 
or  sprayed  with  warm  water,  gradually  brought  down 
to  cold,  and  then  wrapped  in  a  warm  sheet  and  allowed  to 
cool  off  and  rest  on  a  couch. 


Fig.  50 — Horizontal  Electric-light  Bath. 

PhYsiological   Action  : — 

1.  The  electric-light  bath  is  most  valuable  as  a  heating 
agent.  By  a  prolonged  application  the  skin  of  the  patient 
is  reddened,  the  superficial  vessels  dilated,  just  as  in  an 
ordinary  vapour  bath,  for  the  dilatation  and  relaxation 
of  these  superficial  vessels  is  maintained  for  a  considerable 
period  of  time,  and  heat  production  and  elimination  are 
markedly  induced.  In  this  way  the  output  of  COo  is  greatly 
increased,  which  demonstrates  the  powerful  influence  of 
the  bath  on  the  metabolism  of  the  body. 

2.  The  electric-light  bath  induces  free  general  perspiration 
more  rapidly  than  any  other  known  procedure.     The  sweat 

9 


130  NATURAL    THERAPY 

appears  within  five  minutes  of  the  patient  entering  the 
bath,  irrespective  of  the  actual  air  temperature  in  the 
cabinet.  The  time  required  to  induce  diaphoresis  in  an 
ordinary  Turkish  bath  is  very  much  longer ;  indeed  some 
persons  never  perspire  at  all. 

3.  The  body  temperature  rises  rapidly  in  the  electric- 
light  bath — four  to  five  degrees  in  twenty  minutes. 

4.  The  increased  elimination  of  CO2  is  very  marked,  and 
evidences  the  active  oxidation  and  tissue  changes  induced 
by  this  procedure. 

Kellogg  estimates  the  increase  as  nearly  50  per  cent. 
Comparatively,  in  a  Russian  or  Turkish  bath  the 
increase  is  only  found  to  be  10  to  11  per  cent.  The 
respiration  of  the  patient,  while  considerably  quickened, 
is  free  and  unembarrassed.  None  of  the  oppression  and 
distress  met  with  in  the  Turkish  or  Russian  bath  is 
induced. 

5.  The  blood-pressure,  after  a  primary  rise,  is  lowered. 
The  red  cells  are  increased  by  about  15  per  cent.  The 
pulse  rate  is  somewhat  quickened. 

Therapeutic   Effects  : — 

1.  Revulsive  effect. —  By  the  rapidly  induced  and 
prolonged  dilatation  of  the  cutaneous  blood-vessels,  the 
blood  is  diverted  to  the  surface  of  the  body,  and  passive 
venous  congestion  converted  into  an  active  arterial 
hypera^mia.  The  longer  the  bath  is  continued,  the  more 
intense  does  this  effect  become. 

2.  Sudorific  effect. — Perspiration  is  induced  more  quickly 
and  vigorously  than  by  any  other  known  agent,  with  a 
minimum  of  inconvenience  and  discomfort  to  the  patient. 
Copious  water-drinking  during  the  bath  encourages  the 
perspiration  and  keeps  the  blood-volume  constant.  As 
above  mentioned,  the  head  should  be  wrapped  in  cold 
cloths,  especially  if  the  bath  is  prolonged. 

3.  For  promoting  the  absorption  of  morbid  exudates, 
such  as  pleural  effusion,  ascites,  or  joint  effusions,  the 
electric-light  bath  is  admirably  adapted. 

4.  Tonic  effect.  —  A  brief  application — five  to  eight 
minutes — has  a  bracing  and  tonic  effect.  The  after-applica- 
tion of  a  warm  to  cold  spray  and  a  dry  rub  enhances  the 
stimulating  effect. 


PHOTOTHERAPY  131 


Therapeutic  Indications. 


The  condition  of  disordered  metabolism  which  goe;^ 
under  the  name  of  "  uric-acid  diathesis  "  is  much  benefited 
bv  a  series  of  electric-hght  baths. 

By  the  increased  oxidation  and  improved  metabohsm 
the  nitrogenous  by-products  and  toxic  substances  arc 
graduahy  ehminated,  with  proportional  benefit  to  the 
patient.  The  application  should  be  made  two  or  three 
times  weekly,  and  should  be  combined  with  suitable  diet, 
free  water-drinking,  and  plenty  of  exercise.  Allied 
conditions  which  similarly  benefit  are  rheumatism,  gout, 
diabetes,  and  some  forms  of  neurasthenia. 

Fat  glycosurics  are  most  benefited.  The  skin  is  rendered 
more  active  as  an  organ  of  elimination,  and  the  free 
diaphoresis  and  increased  oxidation  reduces  the  amount 
of  sugar  in  the  urine.  The  blood  is  rendered  more  alkaline, 
and  the  tendency  to  "  acid-intoxication,"  so  well  known 
in  this  disease,  correspondingly  diminished. 

Obesity. — In  the  treatment  of  this  condition  the  electric 
light  is  a  most  potent  and  valuable  agent.  As  stated  above, 
the  increase  of  tissue  consumption  during  the  bath  amounts 
to  from  45  to  50  per  cent,  and  as  three-fourths  of  the 
energy  of  the  body  is  consumed  in  heat  production,  the 
value  of  this  is  very  obvious.  An  increase  such  as  this, 
kept  up  for  from  thirty  to  forty  minutes  several  times  every 
week,  naturally  results  in  a  considerable  weight  reduction. 
The  heat  elimination  and  tissue  consumption  is  greatly 
increased  when  the  temperature  of  the  air  surrounding 
the  patient  is  lower  than  the  body  temperature. 

Neuralgia,  including  sciatica,  myalgia,  and  the  various 
vague  pains  associated  with  auto-intoxication,  are  all 
benefited  markedly.  Conditions  such  as  plumbism  and 
arsenical  poisoning  and  neuritis  are  improved,  a  daily 
application  being  sometimes  necessary.  In  a  minor  degree, 
anaemic  conditions  are  benefited  and  the  recuperative 
powers  of  the  body  helped  to  re-establish  the  normal 
hasmopoetic  processes. 

Renal  Disease.— Few  measures  afford  such  marked 
relief  to  acute  and  subacute  renal  disease  as  the  electric- 
light  bath.     Prompt  relief  is  aftorded  to  the  congested  and 


132  NATURAL    THERAPY 

inflamed  organs  by  so  large  a  proportion  of  the  blood  in 
the  body  being  diverted  to  the  skin.  The  application 
should  be  longer  than  usual,  the  patient  being  refreshed 
from  time  to  time  by  a  rub  with  a  friction  glove  wrung 
out  of  cold  water.  The  usual  precautions  as  to  cool 
head  and  warm  feet  are  especially  necessary,  and  great 
care  must  be  also  taken  to  avoid  a  chill,  which  would 
counteract  all  the  good  effects  of  the  bath.  In  acute 
cases  the  bath  may  be  repeated  several  times  in  the 
twenty-four  hours,  and  a  condition  of  continuous 
diaphoresis   maintained. 

In  chronic  "  granular  "  kidney,  special  care  is  needed 
in  prescribing  and  administering,  owing  to  the  risk  of 
apoplexy.  In  cardiac  dropsy  and  hypertrophy  unusual  care 
is  also  necessary,  and  high  temperatures  must  be  avoided. 
The  bath  should  be  brief  in  duration,  and  an  ice-bag  or 
cooling  application  be  placed  on  the  patient's  head.  There 
are  many  other  conditions  for  which  treatment  by  means 
of  the  electric-light  bath  are  of  value  which  need  not  be 
here  entered  into. 

In  conclusion,  one  may  say  with  truth  that  the  therapeutic 
and  hygienic  value  of  the  electric-light  bath  can  scarcely 
be  over-estimated.  It  is  a  most  admirable  and  effectual 
method  of  bringing  into  activity  and  maintaining  in 
operation  the  natural  forces  by  means  of  which  all  elimina- 
tive  processes  are  achieved. 

THE    ROENTGEN    X    RAYS. 

These  were  discovered  by  Roentgen  in  1895,  following  on 
the  work  of  Crookes  and  Lenard.  The  essential  apparatus 
for  their  production  is  a  highly  exhausted  vacuum  tube,  of 
which  there  are  now  many  types,  through  which  an  electric 
current  of  high  potential  is  made  to  pass. 

When  the  exhaustion  reaches  a  degree  of  about  to.^oo  of 
an  atmosphere,  sparks  do  not  pass  between  the  terminals, 
but  the  tube  is  filled  with  a  glow  of  light  caused  by  what 
are  known  as  cathodal  rays.  By  the  impact  of  these  on 
the  anode,  or  anti-cathode  as  it  is  usually  called,  the  X  rays 
are  produced.  These  travel  at  the  same  rate  as  light  rays, 
but  cannot  be  polarized. 


PHOTOTHERAPY  133 

They  are  capable  of  traversing  many  substances,  such  as 
muscle  and  skin,  which  are  opaque  to  ordinary  light  rays,  and 
they  manifest  their  presence  by  their  effect  on  fluorescent 
bodies  or  photographic  plates.  To  these  properties  is  due 
the  value  of  the  rays  as  an  aid  to  diagnosis.  They  also 
possess  a  physiological  action  on  the  tissues  which  may  be 
exceedingly  harmful  as  well  as  beneficial. 

Radiotherapy  is  confined  almost  exclusively  to  derma- 
tology, and  for  full  details  as  to  its  use,  works  on  radiotherapy 
and  dermatology  must  be  consulted.  Apart  from  diagnosis, 
their  use  in  general  medicine  is  not  great  at  the  present  time. 
Their  value  in  diagnosis,  however,  has  recently  been  greatly 
enhanced  by  the  introduction  of  instantaneous  X-ray 
photography  by  Dr.  Groedel,  of  Nauheim,  which  has  been 
popularized  in  Great  Britain  by  Mr.  Schall.  By  means  of 
such  photos  the  diagnosis  of  aneurysms  and  variou.i 
pulmonary  conditions  is  rendered  much  more  accurate. 

THE    FINSEN    LIGHT. 

It  is  impossible  to  deal  with  the  subject  of  phototherapy 
without  mentioning  the  apparatus  introduced  by  the  late 
Prof.  N.  R.  Finsen,  of  Copenhagen.  It  was  first  applied 
by  the  inventor  to  the  cure  of  lupus,  by  focussing  sun- 
light through  water  lenses  pressed  on  the  skin  to  render 
it  anai'mic  and  thus  allow  complete  penetration  by  the  rays. 
Sunlight  being  less  rich  in  the  ultra-violet  rays  than  the 
electric  arc  light,  and  also  being  very  inconstant  in  suppl}', 
Finsen  devised  very  large  arc  lamps  for  the  treatment, 
the  light  being  focussed  on  the  diseased  surface  by 
telescopes  through  quartz  lenses  cooled  by  a  stream  of  water. 
Quartz  allows  of  free  passage  to  the  ultra-violet  rays.  Later 
a  smaller  and  more  portable  form  of  lamp  was  invented — 
the  Finsen-Reyn. 

This  treatment  is  only  of  use  in  dermatology,  and  even  in 
that  class  of  work  has  lately  been  largely  displaced  in  this 
country  by  the  Uviol  vapour  lamp  and  radiotherapy. 


134 


Section    III. — Massage,    Etc.,    in    the 
Treatineut    of   Disease. 


CHAPTER   X. 
MASSOTHERAPY. 


1\ /TASSAGE,  or  massotherapy,  consists  in  the  treatment 
■^^^  of  various  forms  of  disease  by  systematic  manipula- 
tions. The  derivation  of  the  word  is  from  the  Arabic  Mass'h 
— to  press  softly ;  the  Sanscrit  root  being  makch.  There  is 
a  Greek  word,  /.lamru),  meaning  to  handle  or  knead. 

Massage  is  a  very  ancient  form  of  treatment.  In  Chinese 
manuscripts  allusions  to  it  will  be  found  dating  back  to  a 
period  as  remote  as  three  thousand  years  before  the  Christian 
era,  and  there  are  oral  traditions  of  even  greater  antiquity. 
The  manuscript,  Kong  Fao,  the  date  of  which  is  3000  B.C., 
contains  detailed  accounts  of  the  various  manipulations. 
The  practice  seems  to  have  been  common  to  Celestials, 
Persians,  Greeks,  and  Romans.  Much  information  in 
regard  to  the  early  history  of  massage  is  found  among 
the  writings  of  Celsus,  Galen,  Hippocrates,  Oribasius,  and 
other  ancient  writers. 

Hippocrates  says  :  "A  physician  must  be  experienced 
in  many  things,  but  assuredly  also  in  rubbing,  for  things 
which  have  the  same  name  have  not  always  the  same  effect : 
for  rubbing  can  bind  a  joint  that  is  too  loose,  and  loosen  a 
joint  that  is  too  tight.  Rubbing  can  bind,  can  loosen,  can 
make  flesh,  and  can  make  parts  to  waste.  Hard  rubbing 
binds,  and  soft  loosens." 

The  Rom'ans  frequently  employed  massage  after  their 
bath,  just  as  we  employ  the  "  shampoo  "  after  the  Turkish 
bath  at  the  present  day  ;  and  after  the  circus  fights  it  was 
employed  to  restore  sprained  and  stiffened  joints  to  their 
normal  flexibility  and  suppleness.     Homer  tells  how  women 


MASSOTHERAPY  135 

rubbed  and  anointed  veterans  after  the  toil  and  stress  of 
battle. 

A  few  years  ago  massage  was  so  vaunted  and  exploited 
for  commercial  reasons  that  medical  men  were  inclined  to 
regard  it  with  considerable,  scepticism  and  suspicion.  It 
has,  however,  stood  the  test  of  time,  and  we  know  at  the 
present  day  that  it  is  a  reliable  and  powerful  therapeutic 
agent.  The  advertising  "  rubber  "  professes  that  it  will  cure 
almost  any  ill  that  flesh  is  heir  to,  from  obesity  to  con- 
sumption ;  on  the  contrary,  its  sphere  of  action  is  in  most 
hands  comparatively  limited.  Carried  out  under  the 
direction  of  a  trained  and  scientific  physician,  it  may, 
however,  yield  brilliant  results  in  numerous  conditions 
obdurate  to  the  action  of  drugs. 

Some  medical  men  have  a  very  limited  and  unfortunate 
conception  of  the  process.  They  call  it  "  rubbing,"  and 
think  that  any  able-bodied  and  active  man  or  woman  can 
master  the  technique  in  a  few  lessons  and  proceed  to  "  rub  " 
with  good  results.  This  is  far  from  the  truth.  Con- 
siderable training  and  aptitude  are  needed,  and  at  least  an 
elementary  knowledge  of  anatomy  is  essential.  In  the  Ling 
School,  in  Stockholm,  the  course  of  training,  which  also 
includes  medical  gymnastics,  occupies  a  period  of  five  years. 

It  must  be  admitted  that  women  are  more  skilful  and 
successful  at  massage  than  men,  especially  in  "  rest  cures  " 
— their  touch  is  more  delicate,  their  hands  softer  and  more 
flexible.  There  are,  however,  unquestionable  objections  to 
the  application  of  general  massage  by  a  member  of  one  sex 
to  the  other.  Indeed,  it  is  in  connection  with  this  very 
question  that  massage  fell,  some  time  ago,  into  such  disrepute. 

To  the  blind,  above  all,  is  granted  the  '' tadus  eruditus," 
and  in  Japan  massage  is  regarded  as  peculiarly  their 
province.  With  this  idea  they  have  been  trained  from 
time  immemorial,  and  until  recently  none  but  the  blind 
were  so  engaged.  Of  late  years,  however,  people  possessed 
of  their  sight  have  entered  the  arena,  and  the  competition 
has  become  very  keen  in  spite  of  the  low  rate  of  remuneration. 

To  acquire  a  good  knowledge  of  massage,  pupils,  having 
gone  through  a  course  of  good  general  education,  spend 
from  three  to  five  years  in  the  schools  for  the  blind.  When 
found  to  be  an  efficient  masseur,  the  blind  student  either 


136  NATURAL     THERAPY 

takes  a  post  in  one  of  the  schools  as  teacher,  or  starts  on  his 
own  account  as  a  private  masseur.  In  Yokohama,  with  a 
population  of  half  a  million,  there  are  no  less  than  looo  men 
and  women  engaged  in  the  practice  of  massage,  of  whom 
900  are  blind  ;  400  of  these  belong  to  a  guild,  and  600  are 
working  on  their  own  account. 

GENERAL  RULES. 

The  part  to  be  treated  should  be  placed  in  a  posture  of 
complete  repose,  with  the  muscles  quite  flaccid.  It  is 
impossible  to  apply  massage  to  muscles  in  a  state  of  active 
contraction. 

The  entire  limb  should  be  in  the  same  plane,  or  with  the 
distal  portion  somewhat  higher  than  the  proximal,  and  the 
manipulations  are  always  carried  out  in  a  centripetal 
direction,  commencing  at  the  most  distal  point  and  moving 
towards  the  trunk. 

General  massage  is  conveniently  carried  out  with  the 
patient  lying  on  a  bed,  or  on  a  couch  of  twenty-seven  to 
thirty  inches  in  height. 

While  petrissage  and  tapotement  can  be  quite  well 
performed  with  the  patient's  clothes  on,  it  is  best  to  remove 
all  clothing  and  have  the  patient  warmly  covered  with 
blankets,  except  the  actual  part  under  treatment. 

To  avoid  skin  irritation  some  oil  or  vaseline  is  sometimes 
used  ;  a  purified  petroleum  oil,  such  as  "  Dee  oil,"  is  best  ; 
but  unless  the  skin  be  unusually  dry  and  hard,  they  can  all 
be  dispensed  with  ;  and  if  any  lubricant  be  used,  boracic 
acid  will  often  suffice.  The  better  the  masseur,  the  less 
adventitious  aid  of  this  nature  will  he  require. 

The  duration  of  the  seance  will  of  course  depend  on  the 
nature  of  the  case  ;  the  tendency  is  to  give  too  long  a 
time.  For  any  joint,  limb,  or  special  region,  ten  to  fifteen 
minutes  is  ample.  When  general  massage  is  required,  a 
period  of  thirty  to  forty  minutes  will  be  necessary  ;  and  in 
Weir  Mitchell  cases,  up  to  one  hour  twice  daily. 

While  the  methods  of  different  operators  will  vary  some- 
what, the  following  manoeuvres  are  universally  employed  : 

Effleurage,  or  Stroking,  is  a  gentle  stroking  or  roll- 
ing of  the  skin,  gradually  increased  to  moderately  firm 
friction,    always  in    a   centripetal  direction  {Fig.   51).     In 


MASSOTHERAPY 


137 


dealing  with  small  areas  the  palmar  surface  of  the  masseur's 
fingers  are  employed  ;  while  over  large  surfaces  the  whole 
surface  of  the  palm  of  the  hand  is  applied  to  the  skin.  Some- 
times the  ulnar  edge  of  the  hand  is  employed  in  preference. 
Each  stroke  commences  from  the  most  distal  point  on 
the  extremity  under  treatment.  In  the  upstroke  the 
pressure  applied  is  somewhat  firm,  while  in  the  down-stroke, 
which   should   be   absolutely   continuous,   less   pressure   is 


F/o.  51.  — Effleurage  carried  out  with  the  Finger-tips. 


exercised.  From  start  to  finish  of  each  movement  the 
hand  of  the  operator  does  not  leave  the  patient's  skin.  The 
rapidity  of  the  stroke  varies  with  the  effect  which  it  is 
desired  to  produce.  Rapid,  brisk  strokes  of  about  one 
hundred  per  minute  are  stimulating,  while  slower  and  firmer 
strokes  of  seventy  to  the  minute,  or  less,  are  soothing  in  effect. 
Petrissage,  or  Kneading. — This  is  one  of  the  most 
valuable  manipulations,  as  well  as  one  of  the  most  difficult 
to  carry  out  properly  {Fig.  52).     The  skin  and  muscles  are 


P'ig-  52-— Petrissage  with  a  single  Finger  or  Thumb,  to  remove  Inflammatory  Exudates. 


igrasped  and  kneaded,  seriatim,  from  the  peripheral  parts 
to  the  centre  of  the  trunk,  the  hold  being  alternately 
tightened  and  loosened. 


138 


NATURAL    THERAPY 


It  is  of  the  utmost  importance  that  neither  the  skin  nor 
the  hairs  are  dragged  on,  lor  this  is  very  painful  at  the 
time,  and  often  causes  a  crop  of  boils  to  form  later, 
^  which  will  for  the  time- 

being  necessitate  the 
entire  suspension  of 
the  massage.  In  deal- 
ing with  the  larger 
groups  of  muscles, 
such  as  the  quadriceps- 
extensor  groups,  it  is 
well  to  use  both  hands, 
simultaneously  {Fig. 
53).  It  is  sometimes 
possible  in  this  way  to- 
deal  with  the  muscles 
on  either  side  of  a  limb' 
at  the  same  time,  and 
roll  the  muscles  against  the  bone.  This  special  manoeuvre 
is  known  as  "  fulling,"  from  its  similarity  to  the  move- 
ments of  the  fuller  in  linen  bleaching. 


Petrissage  of  the  Fore-arm  with  both  Thumbs. 


Fig.  54.— Tapotcmcnt  witli  the  Dorsal  surface  of  the  Hand. 

Tapotement,  or  Tapping. — This  consists  in  a  series  of  blows- 
struck  in  quick  succession,  either  with  the  fingers,  the  edge  of 
the  hand,  or  the  whole  hand  {Figs.  54, 55).     The  blow  should! 


MASSOTHERAPY 


139 


be  staccato  in  character,  coming  from  the  wrist,  rapidly 
delivered  with  a  certain  rhythm.  To  produce  a  superlicial 
effect  the  fingers  only  are  used,  while  if  we  wish  to  act  on 
the  muscles  and  deeper-lying  structures,  a  series  of  chopping 
strokes  are  given  with  the  ulnar  edge  of  the  hand  along  the 
whole  length  of  the  muscle  in  its  transverse  axis.  Bearing 
in  mind  that  the  object  is  to  produce  a  slight  mechanical 
stimulus  and  not  a  painful  impression,  care  must  be  taken 
that  when  the  whole  hand  is  used,  what  is  intended  to  be  a 
sharp  blow  or  stroke  does  not  degenerate  into  a  smack. 


Fig.  55. — "Hacking" — a  variety  of  Tapotement. 

No  pain  or  bruising  should  be  produced.  When  the  ulnar 
surface  of  the  hand  is  used  {Fig.  55),  the  fingers  should  not 
touch  the  patient's  skin,  and  the  blow  must  come  from 
the  elbow  joint.  To  successfully  carry  out  this  manipulation 
some  delicacy  of  touch  is  requisite,  and  also  considerable 
manual  strength. 

Friction  Massage. — This  consists  in  rubbing  small 
circles  from  the  peripheral  parts  centripetally,  using  the 
whole  hand,  the  thenar  eminences,  or  the  finger  tips,  accord- 
ing to  circumstances.  It  is  of  especial  use  in  treating  joints 
and  any  region  where  kneading  is  impracticable. 


140  NATURAL    THERAPY 

Vibration. — This  is  in  some  respects  a  combination  of 
the  two  preceding  manipulations  {Fig.  56),  a  vibratory  or 
shaking  movement  being  added  to  them.  It  is  probably 
of  all  the  different  massage  manipulations  the  most 
difficult  to  acquire,  and  it  is  the  only  one  which  can  be 
with  advantage  carried  out  by  mechanical  means  (see 
Mechanical  Vibration). 


Fig.  56. — Petrissage  of  the  Arm  Muscles  with  Vibratory  movement. 

GENERAL    MASSAGE. 

While  it  is  immaterial  whether  we  begin  with  a  foot  or 
with  the  upper  extremity,  it  is  well  as  a  matter  of  routine 
to  follow  a  regular  order  ;  for  instance,  legs,  arms,  chest, 
abdomen,  and  back. 

The  patient,  except  for  the  last-named  region,  lies  in  the 
supine  position  throughout,  with  only  so  much  of  his  body 
exposed  as  is  actually  under  manipulation. 

Massage  of  one  extremity  is  much  like  another,  so  that 
what  is  said  of  the  lower  extremity  will  in  large  measure 
apply  to  the  arms.  If  the  hair  of  the  patient's  skin  be 
long,  it  may  save  much  pain  and  trouble  to  shave  the  leg 
close,  or  at  any  rate  crop  it  with  scissors. 

If  the  left  extremity  is  to  be  manipulated,  the  masseur 
will  stand  at  the  patient's  right.  At  the  commencement 
each  toe  is  flexed  and  extended  two  or  three  times  ;  then 
the  ankle,  knee,  and  hip  joint,  etc.     The  patient's  left  foot 


MASSOTHERAPY 


141 


is  taken  in  the  masseur's  left  hand,  while  with  the  right  hand 
on  the  dorsal  surface  he  strokes  towards  the  ankle.  The 
sole  of  the  foot  is  then  kneaded  with  the  fingers,  and  then 
the  skin  around  the  malleoli  and  tendo  Achillis  with  the 
thumb  and  fingers. 

In  treating  the  leg,  the  patient  lies  upon  his  right  side, 
while  the  masseur  is  seated.  Resting  the  patient's  heel  on 
his  knee  or  thigh  {Fig.  57),  a  few  steady  strokes  are  made 
upwards  from  the  level  of  the  ankles. 

The  muscles  of  the  calf  are  then  thoroughly  kneaded,  and 
then  the  muscles  on  the  anterior  aspect  of  the  leg  are 
similarly  dealt  with.     If  the  leg  is  large  and  fleshy,  the  more 


Fig-  57- — Efflenrage  parformed  with  the  entire  Palm  of  the  Hand  rapidly  moved 
towards  the  Knee. 

superficial  layers  of  muscles  are  pressed  and  kneaded  against 
the  deeper  layers  ("  fulling  ") ;  a  little  light  effleurage  then 
quickly  concludes  the  treatment  of  this  region. 

After  stretching  the  skin  around  the  knee  and  applying 
a  little  friction,  the  thigh  is  dealt  with.  Effleurage  is  first 
applied  to  the  whole  thigh  and  hip.  Petrissage  is  then 
applied  to  the  large  groups  of  muscles — quadriceps  cruris 
and  adductors — both  hands  being  used  at  the  same  time. 

The  movements  must  pass  from  below  upwards. 
Effleurage  is  used  at  the  finish  as  usual.  The  patient  13'ing 
on  his  right  side,  effleurage  is  then  carried  out  around  the 
head  of  the  hip  joint ;  with  the  operator's  right  hand,  the  short 
muscles  around  the  trochanter  are  then  carefully  kneaded. 


142 


NATURAL     THERAPY 


In  dealing  with  the  upper  extremity,  the  hand  is 
manipulated  in  much  the  same  manner  as  the  foot ;  the 
thenar  and  hypothenar  eminences  are  thoroughly  kneaded 
and  linished  with  effleurage,  which  is  continued  up  the 
forearm  ;  the  wrist,  elbow,  and  shoulder  joint  are  then 
freely  flexed,  extended  and  circumrotated. 

Holding  the  patient's  left  hand  in  his  right,  the  operator 
thoroughly  kneads  the  muscles  of  the  forearm  on  its  anterior 
and  posterior  aspects.  Similar  treatment  is  then  carried  out 
on  the  upper  arm,  finishing  with  the  shoulder  joint. 


Fig.  58. — Rotation  of  the  Forearm  muscles. 


The  Chest. — The  pectorals  are  treated  with  kneading 
movements  and  tapotement  (sometimes)  and  eifieurage 
carried  out  over  the  rest  of  the  surface  of  the  chest,  the 
posterior  surface  remaining  over  until  the  back  is  treated. 

The  Back. — The  patient  having  been  comfortably 
arranged  in  the  prone  position,  friction  and  kneading  is 
applied  to  the  back  of  the  neck.  Effleurage  follows  along 
the  whole  back,  somewhat  rapid  and  vigorous  in  character. 
Thumb  and  finger  kneading  is  applied  to  the  erector  spinse 
and  deep  muscles  of  the  back,  and  following  this  the  muscles 
of  the  hips  and  buttocks  are  thoroughly  kneaded.     Rapid 


MASSOTHERAPY 


14^ 


effleurage  of  the  whole  surface  of  the  back  is  now  performed, 
with  very  quick  stroking  of  the  skin  over  the  spine,  which 
becomes  reddened. 

Massage  of  the  Stomach. — The  object  of  gastric 
massage  is  twofold,  viz.,  to  increase  the  motility  or  con- 
tractile power  of  that  organ  in  atonic  conditions,  and  at  the 
same  time  increase  the  quantity  and  quality  of  the  secretion. 
Massage,  properly  carried  out,  will  always  increase  the 
acidity  of  the  gastric  juice,  except  when  the  absence  of 
hydrochloric  acid  is  due  to  malignant  disease.  The  gastric 
tenderness    often   present   in    hyperchlorhydria    will    often 


Fig.  59. — Massage  of  the  Stomach. 

prevent  the  performance  of  gastric  massage,  and  this  is  well, 
seeing  the  condition  would  for  the  most  part  be  aggravated 
by  such  manipulation.  In  all  cases  of  diminished  acidity, 
however,  massage  is  helpful. 

To  reach  the  comparatively  limited  area  of  the  stomach 
wall  that  is  accessible  to  touch,  in  the  first  place  the  patient 
must  be  thoroughly  relaxed,  and  deep  manipulations  be 
used  {Fig.  59).  x*\ny  rigidity  of  the  abdominal  muscles  will 
make  the  manipulation  impossible.  If  relaxation  cannot 
be  obtained  with  the  patient  in  the  usual  supine  position, 
with  raised  head  and  drawn-up  knees,  he  should  be  asked  to 


144 


NATURAL     THERAPY 


turn  on  his  right  side,  and  the  masseur  work  from  behind 
him. 

Deep  kneading  and  shaking,  followed  occasionally  by 
vibration  and  slapping,  are  the  movements  most  commonly 
emploved.  The  seance  usually  lasts  ten  minutes,  and  the 
treatment  is  well  given  about  half  an  hour  after  food. 

In  cases  of  atony  and  defective  motility,  when  it  is 
desired  to  aid  the  removal  of  the  gastric  contents  through 
the  pylorus,  after  preliminary  efHeurage  and  kneading,  the 
masseur  should  stroke  firmly  from  left  to  right  across  the 
stomach  with  the  whole  surface  of  the  right  hand,  getting 
the  thenar  eminence  well  in  under  the  left  ribs,  and  then 


Fi^.  60. — Massage  of  the  Abdomen. 

slowly  moving  across  in  a  somewhat  downward  direction. 
It  is  possible  in  a  few  minutes  to  get  rid  of  a  large  amount 
of  food  debris  through  the  pylorus  by  means  of  this  move- 
ment if  efficiently  carried  out. 

Massage  of  the  stomach  is  too  often  superficial,  and  the 
defectively  trained  masseur  soon  reveals  himself  by  rubbing 
in  the  wrong  direction. 

Massage  of  the  Abdomen. — Before  commencing,  the 
patient  should  always  see  that  the  bladder  is  empty,  and  if 
possible  an  action  of  the  bowels  should  be  obtained. 

In  order  to  get  the  muscles  completely  relaxed,  the 
patient's  head  and  shoulders  are  elevated,  his  knees  flexed, 


MASSOTHERAPY 


145 


and  a  request  made  that  he  breathe  deeply  and  regularly. 
The  greatest  difficulty  is  met  with  in  getting  the  proper 
degree  of  relaxation  in  nervous  individuals,  particularly 
women.  A  little  patience,  and  chatty  conversation  to 
distract  the  patient's  mind,  will  generally  overcome  this 
difficulty  after  a  few  minutes. 

In  commencing,  the  masseur  puts  both  his  hands  under- 
neath the  patient  {Fig.  60)  until  they  meet  in  the  lumbar 
region,  and  then  draws  the  hands  forwards,  compressing  the 
patient's  flanks,  and  at  the  same  time  lifting  somewhat 
until  the  hands  again  meet  in  the  mid  line  of  the  abdomen. 


Fii;.  61. — llissage  of  the  Abdomen — (following  the  course  of  the  Colon). 

Deep  kneading  is  begun  in  the  right  iliac  space  with  both 
hands,  and  the  entire  abdomen  is  thoroughly  kneaded 
several  times,  from  the  right  to  the  left  side.  The  left  iliac 
space  is  treated  in  the  same  way,  and  the  colon  is  followed 
throughout  its  entire  course  {Fig.  61)  and  treated  with 
digital  kneading.  More  general  and  heavier  manipulation 
may  be  carried  out  with  the  thenar  eminence  and  list  in 
patients  who  are  tolerant  of  such  manipulation.  The 
concluding  movement  is  light  pressure  of  the  abdomen  with 
the  whole  of  the  operator's  hand,  to  which  he  then  imparts 
a  vibratory  movement. 

A  very  poor  substitute  for  good  abdominal  massage  is 
the  shot  bag — a  stout  canvas  bag  containing  small  shot — 

10 


146  NATURAL     THERAPY 

which  is  moved  about  the  abdomen,  over  the  course  of  the 
colon,  etc.,  by  the  patient  himself.  A  similar  appliance  is 
Sahli's  iron  ball.  Such  massage  is  of  course  elementary  in 
the  extreme  ;  but  in  cases  of  constipation,  where  the  genuine 
article  is  not  available,  either  from  expense  or  other  reason, 
these  manipulations  are  sometimes  of  service. 

The  General  Effects  of  Massage.  —  After  the  con- 
clusion of  each  seance  the  patient  should  be  warmly  covered 
up  and  allowed  to  rest  for  upv/ards  of  half  an  hour. 

A  sense  of  .drowsiness  is  often  experienced,  and  the 
patient  may  fall  asleep.  In  a  few  days  he  will  find  his 
appetite  im.proving,  his  sleep  to  be  sounder,  and  his 
general  condition  improved.  The  skin  becomes  softer,  more 
elastic  and  glossy,  and  fresher  in  colour.  The  veins  are 
more  distinct,  and  there  is  finally  improved  tactile  sensation, 
although  the  immediate  effect  of  massage  is  to  somewhat 
deaden  sensation.  Von  Mosengeil  demonstrated  by  inject- 
ing solutions  of  Indian  ink  into  rabbits'  joints  that  the 
rapidity  of  absorption  was  much  increased  by  massage. 
He  applied  massage  to  one  side  and  not  to  the  other, 
and  found  that  on  the  treated  side  the  lymphatic  glands 
in  the  vicinity  of  the  joint  were  soon  full  of  particles  of 
Indian  ink. 

The  muscular  tone  is  more  rapidly  restored  after  fatigue 
by  massage  than  by  mere  resting,  and  the  muscles  respond 
more  readily  to  electrical  stimuli.  Waste  and  fatigue 
products  are  removed  from  the  muscle  tissue,  and  new 
nourishment  introduced,  and  the  patient  soon  puts  on  weight 
owing  to  the  increased  nitrogenous  metabolism. 

The  force  of  the  cardiac  systole  is  increased  by  massage 
of  the  limbs,  and  the  blood  pressure  raised.  On  the  other 
hand,  abdominal  massage  tends  to  some  degree  of  vascular 
hypotonicity  and  generally  lowered  blood-pressure.  The 
respirations  are  increased  in  both  depth  and  frequency. 
The  red  blood  corpuscles  are  notably  increased,  both  in 
the  healthy  person  and  in  the  anaemic,  after  a  course  of 
massage  ;  there  is  not,  however,  a  proportionate  increase 
in  the  amount  of  hsemoglobin.  Both  the  peristalsis  of  the 
stomach  and  its  secretory  power  are  markedly  stimulated 
by  local  massage.  Intestinal  peristalsis  is  also  increased, 
while  the  activity  of  the  liver  is  similarly  affected. 


MASSOTHERAPY  ui 

The  temperature  of  the  whole  body  is  temporarily  raised 
about  1°  C,  but  rapidly  returns  to  the  normal. 

Therapeutic  Ixdicatioxs. 

Dyspepsia  and  Constipation  are  frequently  markedly 
relieved  by  judicious  massage.  In  the  former  condition  it 
is  of  special  importance  to  see  that  the  massage  is  not 
out  of  proportion  to  the  amount  of  food  which  the 
patient  is  taking — and  assimilating.  If  caution  be  not 
observed,  weight  loss  is  easily  increased.  As  the  appetite 
improves,  more  food  is  consumed,  and  with  improved 
assimilation  the  duration  of  massage  can  be  slowly 
increased. 

In  constipation  the  massage  should  be  applied  in  the 
early  morning  before  the  patient  dresses,  so  as  to  induce  a 
healthy  action  of  the  bowels  at  the  usual  time.  Both  the 
abdominal  muscles  and  the  intestinal  wall  should  be 
influenced.  Beginning  in  the  region  of  the  csecum,  the 
operator  should  work  up  the  right  side  of  the  abdomen, 
along  the  transverse  colon,  just  above  the  level  of  the 
umbilicus,  and  down  the  left  side.     (See  Fig.  6i). 

After  superficial  movements  have  been  performed,  the 
pressure  should  be  increased,  and  the  hands  given  a  rotatory 
motion  and  made  to  follow  the  line  of  the  colon. 

The  abdomen  should  be  so  treated  for  about  fifteen 
minutes  daily,  and  the  treatments  kept  up  for  a  month  or 
six  weeks,  according  to  results.  The  movements  can  later 
be  imitated  by  the  patient  himself  by  means  of 
the  '■  shot-bag,"  though,  of  course,  this  is  much  inferior  to 
manual  treatment. 

Insomnia  is  commonly  greatly  benefited  by  general  and 
abdominal  massage,  which  should,  however,  be  applied 
late  in  the  day. 

Joi)it  Affections. — Various  sprains  and  synovial  infla.m- 
matory  conditions  are  much  improved  by  massage.  The 
most  striking  results  are  seen  in  cases  where  the  joint  has 
become  stiff  and  useless  from  disuse,  and  the  muscles 
atrophied.  In  these  cases  initial  breaking  down  under  an 
anaesthetic  is  often  required.  Chronic  rheumatoid  arthritis, 
while  somewhat  helped,  is  less  yielding  to  the  application 
of  massage  than  gout  or  gonorrhoeal  rheumatism. 


148  NATURAL     THERAPY 

In  these  conditions  active  treatment,  for  ten  to  fifteen 
minutes  twice  daily,  should  be  kept  up,  combined  with 
various  hydro  therapeutic  applications. 

Generally  speaking,  acute  inflammatory  joint  conditions 
are  best  left  alone  by  the  masseur.  At  the  same  time,  in 
acute  cases  gentle  manipulation  may  be  begun  very  early 
after  the  injury. 

Nervous  Affections  and  Myalgia. — In  obstinate  sciatica 
local  massage  may  be  of  great  service  ;  an  initial  "  dry 
stretching  "  is  often  indicated,  then  kneading  of  the  muscles 
and  skin  stroking. 

Other  forms  of  neuritis  are  equally  benefited.  Rheumatic 
and  gouty  myalgia,  lumbago,  etc.,  frequently  yield  in  a  few 
days  to  this  mode  of  treatment.  In  regard  to  the  muscles, 
it  must  also  be  borne  in  mind  that  when  a  patient  has  been 
compelled  to  keep  his  bed  for  some  weeks,  owing  to  a  fracture 
or  some  illness,  convalescence  and  ability  to  walk  are  much 
helped  by  applying  massage  to  the  limbs  a  week  or  ten  days 
prior  to  getting  up. 

Other  conditions  in  which  massage  is  indicated  are 
ansemia,  obesity,  drug  habit,  chorea,  and  neurasthenia. 

Local  manipulation  of  the  uterus,  etc.,  in  subinvolution 
and  similar  conditions,  is  essentially  objectionable,  nay, 
disgusting,  when  performed  by  physician  or  masseur ; 
hardly  less  so  when-  carried  out  by  a  masseuse. 

Conditions  Not  Benefited  by  Massage. 

The  indiscriminate  use  of  massage  is  to  be  strongly  con- 
demned, for  there  are  numerous  conditions  for  which  it  is 
perfectly  useless,  and  not  a  few  when  it  is  absolutely  hurtful 
and  even  dangerous.  Instances  of  the  latter  are,  in  general 
massage,  venous  thrombosis,  and  in  abdominal  massage, 
severe  gastric  ulcer. 

In  febrile  conditions  the  temperature  is  further  raised  ; 
in  acute  renal  disease  or  pulmonary  tuberculosis  it  may 
induce  a  haemorrhage.  It  may,  however,  be  employed  in 
phthisis  during  a  quiescent  period.  Abdominal  massage 
should  never  be  employed  when  the  patient  is  menstruating 
or  pregnant. 

Common  sense  will  negative  the  use  of  massage  where 
there  is  any  considerable  solution  of  continuity  in  the  skin 


MASSOTHERAPY 


119 


of  the  patient,  be  the  immediate  cause  a  burn,  an  ulcer,  or 
a  cut.  In  any  dermatitis,  of  course,  harm  will  be  done  and 
the  condition  be  aggravated  by  massage. 

VIBRATION     BY    MECHANICAL    MEANS. 

The  performance  of  vibration  by  the  hand  must  of 
necessity  be  more  or  less  limited  as  to  time  and  rapidity 
of  motion.  The  hand  and  fingers  soon  grow  weary,  though 
in  this,  as  with  the  ergograph,  practice  enables  a  much 
greater  amount  of  work  to  be  carried  out. 


Fig.  62 — The  "Ruk"  Vibrator,  being  applied  by  Patient  himself. 

Mechanical  vibration  is  an  admirable  adjuvant  to 
ordinary  massage,  and  is  one  of  the  most  important  passive 
movements  used  in  medical  gymnastics.  There  is  no  dcubt 
that  a  machine-driven  instrument  can  produce  effects 
unattainable  b}^  means  of  the  human  hand.  The  effect 
may   be   made   stimulating  or  soothing  as   desired,  while 


150 


NATURAL     THERAPY 


the  circulation  in  any  part  can  be  improved,  and  the 
absorption  of  any  morbid  effusion  be  hastened.  Twenty- 
five  or  thirty  years  ago,  Bourneville  introduced  mechanical 
vibration  as  a  method  of  treatment  in  nervous  diseases, 
particularly  for  neuralgias,  and  it  was  used  with  consider- 


Fig.  63— The  "Barker"   Vibrator. 

able  success  at  the  Salpetriere  and  other  hospitals.  In 
the  early  eighties,  Dr.  Mortimer  Granville  produced  a 
vibrator,  worked  by  a  magnetic  battery.  An  apparatus 
driven  by  hand,  such  as  the  Liedbeck  or  the  Veedee, 
may  in  these  days  of  electricity  be  practically  put  out  of 
court.    Almost  every  electrician  has  some  form  of  vibrator — 


MASSOTHERAPY  isi 

often  not  expensive — in  his  catalogue,  which  can  be 
attached  to  a  motor,  and  worked  in  any  house  where  the 
electric  current  is  laid  on.  Such  an  apparatus  can  often 
be  worked  by  the  patient  unassisted,  and  the  motion  is 
not  of  the  jerky  character  which  is  almost  inevitably 
associated  with  a  vibrator  worked  by  hand.  One  of  the 
best  of  these  apparatus  is  the  "  Ruk  "  {Fig.  62),  made  by 
Schall ;  it  is  comparatively  inexpensive,  and  merely  requires 
to  be  connected  to  the  nearest  lampholder  or  wall  plug.  It 
gives  regular  strokes  in  rapid  succession  as  soon  as  the 
switch  is  closed,  and  the  intensity  of  the  strokes  can  be 
suited  to  every  patient. 

Another  apparatus  (on  which  the  Lancet  has  reported 
favourably)  is  the  "Barker"  vibrator  {Fig.  63).  This  is  one 
of  the  very  best  on  the  market,  and  is  extremely  comfortable 
to  the  patient.  There  is  no  jerking  or  jarring  movement, 
the  machine  is  practically  noiseless,  the  vibrations  are  even 
in  character,  and  the  effect  on  the  patient  is  similar  to  that 
produced  by  a  rapidly  alternating  current.  With  each 
machine  are  supplied  a  large  number  of  "  applicators " 
adapted  to  almost  every  region  of  the  body. 


152 


CHAPTER     XL 
THE     REST     CURE. 

THERE   are   three   essential   factors   in    the    rest    care. 
These  consist  in  : — 

1.  Absolute  rest  in  bed. 

2.  Isolation  from  friends,  letters,  etc. 

3.  Abundant  feeding. 

4.  Massage  and  electricity. 

Weir  Mitchell,  of  Philadelphia,  was  the  first  physician 
who  systematically  employed  these  methods  in  combina- 
tion ;  and  the  late  Sir  W.  S.  Play  fair  introduced  the 
treatment  into  this  country,  and  used  it  extensively 
with  great  success. 

The  class  of  patient  in  whom  the  most  striking  results 
are  obtained  are  neurotic  individuals  of  either  sex,  who 
have  become  emaciated.  Some  such  cases  have  broken 
down  from  sheer  overstrain,  where  initially  there  was  not  a 
big  supply  of  nerve  energy  to  draw  upon.  Others  have 
gradually  brought  themselves  into  a  condition  of  ill-health 
and  complete  nervous  exhaustion  from  cultivating  "  diet  " 
fads  or  leading  idle,  useless,  unwholesome,  if  not  vicious, 
lives. 

Some  may  evidence  the  condition  "known  as  "  anorexia 
nervosa,"  and  either  refuse  food,  take  very  little,  or,  worse, 
vomit  what  they  do  take  immediately  the  meal  is  finished. 
Vomiting  may  alternate  with  diarrhoe^a.  The  emaciation  is 
often  slow  in  such  cases,  but  the  ultimate  condition  of  the 
patient  is  practically  skin  and  bone  ;  in  other  words,  at 
the  commencement  of  the  "  cure,"  such  patients  are 
frequently  in  a  condition  of  the  most  profound  emaciation. 

The  following  weights  are  instances  : — 

Female,  aet.  22  ;    5ft.  Sin.  ;    weight,  821b. 
Male,       .et.  24  ;  5ft.  6in.  ;     weight,  7st.  ilb. 
Male,       set.  23  ;  6ft.  2in.  ;    weight,  8st.  31b. 


THE     REST     CURE  153 

Such  patients  are  usually  markedly  ansemic,  listless, 
apathetic,  depressed  if  not  tearful ;  the  skin  is  loose 
and  dry,  and  mind  and  body  are  enfeebled  to  the  last 
degree. 

While  they  occasionally  resent  the  confinement,  and 
protest  at  the  frequent  feeding  for  the  first  day  or  two, 
they  soon  become  accustomed  to  the  routine,  especially 
if  provided  with  a  cheerful  and  tactful  nurse.  Any  in- 
subordination, if  firmly  dealt  with  at  the  start,  usually 
ceases  very  speedily,  and  reasoning  with  a  patient  may 
often  do  much  to  this  end. 

I.  Rest. — In  regard  to  this  factor,  it  cannot  be  too 
forcibly  insisted  that  the  rest  must  be  complete.  For 
from  four  to  eight  weeks,  or  even  longer  in  severe  and 
slowly  progressing  cases,  the  patient  must  be  kept  in  bed, 
without  intermission,  night  and  day,  only  leaving  it 
morning  and  evening  to  be  placed  on  another  bed  or  couch 
while  the  first  bed  is  being  made. 

In  severe  cases  a  bed-pan  must  be  used.  Food  must  be 
cut  up  or  suitably  prepared,  and  neither  reading,  writing, 
nor  sewing  must  be  allowed. 

The  ennui  resulting  from  this  severe  regime  is  not 
so  great  as  one  might  expect.  If  good  progress  is  being  made 
the  patient  dozes  or  sleeps  a  great  deal  during  the  day, 
and  two  hours'  m.assage,  some  galvanism,  and  frequent 
meals  go  far  to  fill  up  the  waking  time. 

Any  relaxation  of  the  rules  will  depend  entirely  on  the 
progress  made  ;  but  in  a  case  of  moderate  severity,  which 
is  doing  well,  some  light  reading,  such  as  the  daily  papers. 
Punch,  or  pictorials,  may  be  allowed  at  the  end  of  the  third 
week,  and,  later,  se\\dng  or  an  unexciting  novel.  Gradually 
a  little  sitting  up  in  the  afternoon  may  be  also  permitted. 
This  period  is  gradually  lengthened,  and  at  the  end  of 
the  sixth  week  change  to  another  room,  or  a  walk  on  a 
verandah,  may  be  allowed. 

A  large  airy  room,  well  lighted,  with  a  south  exposure, 
is  best  for  such  cases.  A  night  and  day  nurse  ma}-  be 
required,  but  generally  speaking  it  is  best  to  have  the  same 
nurse  sleeping  in  the  patient's  room  or  a  dressing-room, 
and  a  special  masseuse  visiting  twice  daily,  and  temporarily 
relieving  the  nurse. 


154  NATURAL    THERAPY 

Too  much  importance  cannot  be  laid  on  the  choice  of 
the  nurse.  Great  judgment  is  needed  in  this  particular, 
and  the  success  or  failure  of  the  "  cure  "  will  largely  depend 
on  the  nurse's  teiriperament  and  capacity.  She  must  be 
possessed  of  a  high  degree  of  patience,  and  her  sympathy 
must  be  tempered  with  discretion. 

2.  Isolation. — This  is  essential,  and  must  for  the  first  four 
weeks  be  absolute.  To  attempt  to  carry  out  this  treatment 
in  the  patient's  own  home  is  worse  than  useless.  The  place 
matters  little  apart  from  this,  and  provided  the  immediate 
environment  of  the  patient  is  cheerful  and  peaceful,  a  good 
nursing  home  or  hvdropathic  sanatorium^  is  equally  suitable. 
No  letters  must  be  written  or  received,  and  no  person 
permitted  to  enter  the  patient's  room  except  the  physician, 
nurse,  masseuse,  and  the  maid  who  cleans  it  and  attends 
to  the  fire. 

3.  Feeding. — As  regards  diet,  the  line  adopted  is  an 
ample  supply  of  appetizing,  easily  digested  food  at  regular 
but  frequent  intervals.  Where  the  patient  is  very  low 
down,  and  digestion  much  enfeebled,  a  start  has  often  to 
be  made  with  milk  or  peptonized  milk.  To  some  patients 
this  is  distasteful  in  the  extreme,  while  others  are  completely 
upset  by  it,  acquire  a  dirty  tongue,  and  lose  weight. 

The  addition  of  barley-  or  lime-water  sometimes  helps 
matters,  but  to  those  who  have  "  the  indigestion  of  fluids  " 
described  by  Fothergill — in  other  words,  a  degree  of  gastric 
myasthenia — a  more  solid  diet  is  better  suited.  A  beginning 
can  be  made  with  chicken  puree,  creamed  fish,  plasmon 
cream,  and  rusks,  and  the  patient  gradually  worked  up 
to  a  full  diet.  All  drugs  are  best  avoided,  particularly 
digestive  enzymes,  etc.  ;  at  the  most  some  mild  aperient 
medicine  may  be  required  at  first,  as  }  gr.  calomel,  nightly, 
while  milk  is  taken. 

The  following  is  a  typical  diet  for  such  a  patient  : — 

7.30  a.m.     Cafe  au  lait,  and  bread  and  butter. 

8.30  a.m.     Tea  or  cocoa,   with  cream  or  milk  ;     2   fried  sole 

fillets  ;     toast  and   butter  ;    jam  or   marmalade, 

ad  lib. 
1 0.0  a.m.     A  glass  of  milk  and  rusk. 
12.0  noon.   A  whole  cup  of  beef-tea. 
I.I 5  p.m.     A  large  helping  of  chicken  or  pheasant,  vegetables, 

and  milk  pudding. 


3' 

■  O 

p.m. 

4' 

•30 

p.m, 

6. 

,0 

p.m. 

7' 

•30 

p.m, 

lO.O 

p.m. 

THE     REST     CURE  155 

A  cup  of  Benger's  food — \  pint. 

Tea,  biscuits  and  bread  and  butter,  and  a  boiled  egg. 

A  cup  of  beef-tea. 

A  large  plate  of  meat,  vegetables,  and  pudding  as 

at  lunch. 
A  glass  of  hot  milk  and  a  biscuit. 

The  nurse  must  see  that  the  meals  are  served  regularly, 
and  should  keep  a  careful  record  of  how  much  the  patient 
takes. 

The  patient  is  usually  weighed  once  a  week,  or  sometimes 
oftener ;  but  care  must  be  taken  in  many  cases  to  keep  the 
weight  a  secret,  as  some  patients  are  unduly  depressed  if 
there  is  a  loss  of  weight  or  the  gain  is  slow  ;  while  in  female 
patients,  if  the  gain  be  rapid,  say  6  lb.  in  one  week,  they 
may  refuse  to  eat  so  much  in  case  they  get  too  stout !  This 
is  by  no  means  unusual. 

The  food  is  gradually  diminished  during  the  last  week. 

Hale-White  and  Spriggs  have  carefully  investigated  the 
metabolism  of  a  patient  during  the  rest  cure.  The  food 
supplied  during  an  eight  weeks'  course,  and  the  urine 
and  fgeces,  were  carefully  weighed  and  measured.  At  the 
commencement  the  patient's  weight  was  6  st.  4  lb.,  and 
the  gain  in  weight  was  30  lb.  The  physiological  heat  value 
of  a  day's  food  was  found  to  be  5,300  calories.  The 
daily  average  intake  of  fat  was  268"69  gm.,  and  96-5 
per  cent  was  absorbed.  The  absorption  of  nitrogen  was 
found  to  be  very  complete  during  the  course,  only 
661  gm.  being  unabsorbed.  It  was  found,  however,  that 
after  making  due  allowance  for  nitrogen  in  urine,  sweat, 
and  catamenia,  there  was  still  10  per  cent  unaccounted  for  ; 
the  explanation  being  either  that  these  were  more  con- 
centrated at  the  end  of  the  treatment,  or  that  the  nitrogen 
was  laid  up  in  the  form  of  some  compound  more  nitro- 
genous than  proteid. 

4.  Massage. — The  object  of  the  massage  is,  of  course,  to 
take  the  place  of  normal  physical  exercise,  improve  the 
circulation,  and  hasten  the  removal  of  waste  products 
from  the  tissues.  The  whole  body  is  treated,  with  the 
exception  of  head  and  face. 

Beginning  the  first  day  with  ten  minutes  morning  and 
evening,  the  amount  is  rapidly  increased  up  to  an  hour 
twice  daily  at  the  end  of  the  first  week,  and  is  maintained 


156  NATURAL     THERAPY 

at  that  until  the  patient  begins  to  move  about  a  httle, 
when  it  is  gradually  decreased  until  exercise  is  taken  freely. 
The  immediate  effect  of  massage  is  drowsiness  and  some 
degree  of  hunger,  so  that  it  is  well  to  follow  the  massage 
time  with  a  light  meal,  and  then  allow  an  hour  for  sleep. 
During  menstruation  the  massage  is  continued,  the  abdomen 
being  omitted.  Some  physicians  combine  faradism  with 
the  massage,  but  it  does  little  good  beyond  filling  in  the  time. 
Central  galvanism,  however,  may  be  helpful  in  some  cases. 
The  limbs  and  trunk  should  be  sponged  daily — seriatim — - 
with  cold  or  tepid  water,  and  dried  with  a  rough  towel. 

The  results  of  this  somewhat  remarkable  treatment  are 
equally  remarkable,  and  the  improvement  in  physical 
health  and  gain  in  weight  often  perfectly  astonishing. 
A  very  usual  increase  in  weight  during  a  six  weeks'  course 
is  1^  to  2  St.  Hale-White  records  a  gain  of  as  much  as 
9  lb.  12  oz.  in  one  week,  and  Graham  Brown  of  9  lb. —  the 
latter  with  milk  alone.  These  are  exceptional,  and  one 
should  be  perfectly  satisfied  with  a  steady  gain  of  from 
3  to  5  lb.  per  week. 

As  in  the  results  of  gastro-enterostomy  for  dyspeptic 
conditions,  the  thinner  the  patients  are  at  the  start  the 
more  striking  is  the  gain  in  weight.  Indeed,  the  patients 
who  benefit  most  in  every  way  are  the  absolutely  emaciated 
worn-out  neurasthenics.  Fat,  hysterical  types,  in  whom  the 
mental  element  predominates,  do  not  improve  to  the  same 
extent  ;  indeed  the  gain  in  weight  may  become  a  mere 
added  encumbrance.  Any  organic  gastric  trouble,  such  as 
an  ulcer  which  bleeds,  or  enteritis,  is  a  bar  to  success  ; 
but  gastralgia  and  neuralgias  of  many  regions  disappear 
like  magic  in  the  vast  majority  of  cases. 

Romberg  defined  "  pain  "  as  "  the  prayer  of  a  nerve 
for  healthy  blood  "  ;  if  a  superabundant  supply  of  healthy 
blood  is  forthcoming,  the  pain  goes. 

If  the  patient  has  drug  habits,  the  usual  difficulties  have 
to  be  contended  with  ;  but  provided  the  habit  is  broken 
off  they  do  well. 

While  some  weeks  may  pass  before  the  patient  is  inclined 
or  able  to  take  a  great  deal  of  exercise,  still,  in  the  large 
majority  of  cases,  at  the  end  of  the  course,  the  patient  is  in 
excellent  health.     Relapses  do  occur,  but  much  will  depend 


THE     REST     CURE  157 

on  the  after  environment  of  the  patient.  A  short  sea- 
voyage  or  a  few  weeks  in  Switzerland  are  excellent  sequels 
to  the  period  of  incarceration. 

The  cost  of  such  a  course  of  treatment  in  a  London 
nursing  home  is  exceedingly  heavy — from  £iS^  to  £250 — 
more  if  especially  good  rooms  are  engaged.  In  most 
well- organized  sanatoria  and  hydropathic  establishments, 
£8  8s.  to  £10  los.  per  week  will  cover  the  cost. 

A  modified  course  is  often  successful  in  mild  cases,  but 
the  one  rule  that  can  never  be  modified  is  that  in  regard' 
to  isolation  from  friends,  for  no  degree  of  success  can  be 
hoped  for  if  the  patient  is  not  removed  from  the  usual 
environment,  which  often  constitutes  a  large  proportion 
of  the  causus  morbi. 


158 


Section    IV. — Electricity  in   the   Treatment 
of  Disease. 


CHAPTER   XII. 
GALVANISM     AND     FARADISM. 

HISTORICAL     SUMMARY. 

ELECTROTHERAPEUTICS  date  back  to  a  legendary 
^-^  age.  Centuries  ago,  it  is  said,  the  women  of  Africa 
bathed  their  sick  children  in  waters  frequented  by  the 
electric  eel  or  torpedo  {Malapterurus  electricus). 

Earlier  still,  the  Romans  employed  electricity  in  the 
elementary  forms  then  available,  for  the  treatment  of 
disease.  During  the  reign  of  Tiberius  electricity  was 
employed  by  Scribonius  Largus  in  the  treatment  of  gout. 

Professsor  Crookes  humorously  attributes  the  death  of 
Tullus  Hostilius,  who,  according  to  Roman  mythology,  was 
struck  dead  by  one  of  Jove's  thunderbolts,  to  accidental 
contact  with  "  a  live  wire  !  " 

Phny  and  Dioscorides  both  refer  to  the  remedial  powers 
of  electricity. 

The  history  of  electrotherapeutics  may  be  divided  into 
four  eras  :  (i)  The  era  of  Franklinization  ;  {2)  The  era  of 
Galvanization  ;  (3)  The  era  of  Faradization  ;  (4)  The  era 
of  Radiology,  High-Frequency,  and  Sinusoidal  treatment. 

I.  The  Era  of  Franklinization.^One  of  the  prominent 
advocates  of,  and  writers  on,  franklinic  electricity  as  a  thera- 
peutic agent  was  John  Wesley,  the  divine.  At  a  time  when 
the  medical  faculty  were  inclined  to  despise  electricity  and 
underrate  its  value  (as  unhappily  many  members  of  the 
profession  still  are),  Wesley  claimed  that  electricity  was 
indicated  in  a  wide  range  of  disorders  ;  and  with  the  list  of 


GALVANISM  AND  FARADISM    159 

ailments  which  he  drew  up  as  suitable  for  electrical  treat- 
ment, the  modern  physician  who  has  studied  electricity  will 
find  no  grave  fault.  Independently  of  Franklin,  Wesley 
also  suggested  the  use  of  lightning  conductors. 

2.  The  Era  of  Galvanization. — This  was  commenced  by 
Galvani's  classical  experiment  on  the  frog  in  1786.  After 
his  results  were  made  public,  Volta  was  attracted  to  the 
field  of  electrical  experiment,  and  constructed  his  pile,  which 
from  the  year  1800  onwards  was  largely  employed  in 
medical  work,  and  marked  a  distinct  advance  in  technique. 

Unfortunately,  most  of  the  work  at  this  period  was  done 
by  laymen,  who  knew  little  or  nothing  of  physiology  or 
medicine.  "  Chemists,  physicists,  priests,  paupers,  monks, 
and  mountebanks  were  the  leading  authorities  on  electro- 
therapeutics in  the  eighteenth  century." 

Many  years  elapsed  before  electrotherapy  attained 
sufficient  precision  to  command  the  attention  of  men  of 
science. 

3.  The  Era  of  Faradization. — Michael  Faraday's  discovery 
of  the  principle  of  electrical  induction  in  1831  may  be  said 
to  have  changed  the  whole  course  of  electrotherapeutics. 
Tn  the  following  year  the  first  practical  machine  on  this 
principle  was  made  by  Pixii,  and  used  by  Neef  of  Frankfort 
in  the  treatment  of  disease.  From  this  time  faradic 
electricity  became  extensively  employed  throughout  Europe. 
Until  1895  galvanism,  faradism,  and  perhaps  to  a  less 
extent  static  electricity,  were  the  forms  employed  in 
medicine.  The  apparatus  required  w-as  not  very  elaborate, 
and  the  amount  of  work  done  in  a  large  general  hospital 
w^as  often  scarcely  sufficient  to  justify  the  existence  of  a 
special  electrical  department. 

4.  The  X-rav  Period. — The  discovery  of  X  rays  by 
Professor  Roentgen  in  1895  undoubtedly  gave  an  enormous 
impetus  to  electrical  work,  and  led  to  the  establishment 
of  a  radiographic  and  electrical  department  in  all  large 
hospitals.  The  field  for  the  electro  therapeutist  expanded, 
and  electrical  treatment  to  some  extent  was  taken  out  of 
the  hands  of  the  "  medical  electrician,"  or  electrical  quack. 

Soon  after  this  remarkable  results  were  obtained  by 
d'Arsonval,  Elihu  Thomson,  and  Tesla,  by  the  use  of  "  high- 
frequency  "   currents,  which  rushed  into   fashion,   became 


160  NATURAL     THERAPY 

discredited,  and,  latterly,  are  again  obtaining  a  place  in 
electrotherapy.  Sinnsoidal  currents  have  of  late  been  much 
used,  chiefly  through  the  advocacy  of  Herschell  and  Morton. 
During  the  past  century,  associated  with  all  that  is  best 
in  the  application  of  electricity  to  the  treatment  of  disease 
are  the  names  of  Faraday,  Duchenne,  Meyer,  Edelmann, 
von  Ziemssen,  Kelvin,  Becquerel,  Rockwell,  and  Milne 
Murray. 

GENERAL     USE     OF     ELECTRICITY 
IN     MEDICINE. 

Erb  has  defined  electrotherapeutics  as  consisting  in 
placing  the  human  body — or  a  portion  of  it — in  the 
external  circuit  of  an  electric  current  ;  in  other  words, 
in  submitting  it  to  a  current  of  variable  strength  and 
duration,  brought  to  it  through  the  electrodes,  with  or 
without  interruptions  or  changes. 

While  the  indiscriminate  use  of  electricity  is  to  be  strongly 
condemned,  as  foolish  if  not  actually  dangerous,  its  value 
in  the  treatment  of  many  forms  of  disease  is  unquestionable. 
Too  great  care  cannot  be  exercised  in  the  judicious  selection 
of  cases  suitable  for  treatment,  and  equal  consideration 
must  be  devoted  to  the  type  of  electricity  used,  the  means 
of  application,  and  the  strength  of  the  current  advisable. 
For  some  cases  galvanism  may  be  useless,  for  others  faradic 
electricity  may  be  highly  injurious.  Much  harm  has  been 
done  to  electrotherapy,  and  its  progress  in  the  treatment 
of  disease  been  greatly  checked,  by  the  prejudice  aroused 
against  it  owing  to  its  having  fallen  so  much  into  the 
hands  of  unscrupulous  charlatans  who  have  run  it  as  a 
"  cure  all,"  and,  by  means  of  electropathic  belts  and  other 
figments,  imposed  on  the  credulous  public  and  made  harvest 
out  of  their  gullibility.  Properly  applied,  in  its  various 
forms,  electricity  has  the  following  therapeutic  effects  : — 

1.  It  stimulates  all  the  body  tissues,  and  is  of  especial 
value  in  this  respect  as  regards  muscles,  nerves,  and 
secretory  glands. 

2.  It  promotes  nutritive  processes  and  improves  the 
patient's  general  health. 

3.  It  increases  metabolic  processes. 


p.  X 


GALVANISM  AND  FARADISM    i6i 

4.  While  in  the  main  stimulating,  it  may  often  relieve 
morbid  irritability. 

5.  It  is  of  immense  value  in  diagnosis  of  various  nerve 
lesions,  as  a  means  of  ascertaining  the  existence  of  what 
is  known  as  "  the  reaction  of  degeneration,"  the  myasthenic 
reaction,  etc.,  and — by  radiography — in  many  morbid 
conditions. 

It  is  not  proposed  to  deal  in  this  short  section  with  the 
details  of  all  the  various  batteries,  etc.,  employed  in 
electrical  work,  or  with  the  elementary  theory  of  the  science. 
For  the  description  and  explanation  of  the  various  chemical, 
physical,  and  physiological  effects  produced  by  the  appli- 
cation of  electricity,  the  reader  is  referred  to  one  of  the 
many  excellent  text-books  on  the  subject,  such  as  those 
of  Lewis  Jones  and  Wilfred  Harris,  or  the  large  work  of 
Beard  and  Rockwell. 

Space  only  permits  the  writer  to  deal  somewhat  briefly 
with  the  employment  of  electrotherapy,  used  as  it  should 
be,  as  an  adjuvant  of  its  sister-methods  of  natural  therapy, 
viz.,  diet,  massage,  and  hydriatric  measures. 

SOURCES     OF     ELECTRICITY     FOR     MEDICAL 
PURPOSES. 

For  galvanization  and  faradization  the  electrical  energy 
may  be  derived  from  batteries  made  up  of  a  larger  or 
smaller  number  of  units  (cells),  or  it  may  be,  and  now 
commonly  is,  obtained  from  a  dynamo  (the  main).  As  a 
wall  plug  is  not  always  available  or  conveniently  situated, 
it  is  frequently  more  convenient  to  use  a  small  portable 
galvanic  or  faradic  battery. 

For  the  production  of  static  electricity,  we  commonly 
use  the  machines  of  Holtz  or  Wimshurst,  the  latter  being 
most  favoured.  The  recently  introduced  Gaiffe-d'Arsonval 
apparatus,  whereby  static  electricity  is  obtained  by  means 
of  a  transformer  from  the  main,  is  very  convenient  {Plate 
XXVI). 

THE    GALVANIC    OR    CONTINUOUS    CURRENT. 
Choice    of  the    Cell   for    Batteries. — It  is   impossible    to 
give  the  preference  to  one  certain  cell  under  all   circum- 
stances, as  these  will  differ  verj^  considerably.     Any  cell 

11 


162  NATURAL    THERAPY 

can  be  used  which  is  capable  of  yielding  the  desired 
strength  of  current ;  but  if  we  consider  convenience,  the 
time  necessary  to  keep  a  battery  in  working  order,  its 
portability,  etc.,  the  number  of  useful  cells  will  be  reduced 
to  very  few  indeed,  and  these  only  will  be  mentioned  here. 

In  choosing  a  battery,  an  important  consideration  is 
whether  it  can  be  charged  by  the  physician  himself,  or 
whether  it  has  to  be  returned  to  the  maker  when  exhausted. 
In  the  latter  case  the  battery  would  be  suitable  only  for 
those  medical  men  who  live  within  convenient  reach  of 
the  manufacturer.  The  capacity  of  the  battery,  i.e.,  the 
amount  of  current  which  it  will  yield  before  having  to  be 
recharged,  the  cost  of  recharging,  the  price  of  the  battery, 
and  its  size  and  weight  are  important. 

It  stands  to  reason  that  cells  with  high  E.M.F.  and  small 

internal   resistance    have    a    considerable    advantage    over 

cells   with   low   E.M.F.    and   high  internal   resistance,   for 

50  chloride  of  silver  cells  with  i  volt  and  8  ohms  internal 

resistance  each,  when  connected  in  series  will  yield  with 

an  external  resistance  of  2,500  ohms — 

50  volts 

, ^ , =  0-0172  ampere,  or  —   17-2 

(50    X    8)    +  2,500  ohms  /  r      '  / 

milliamperes ;  whereas  22  bichromate  cells  of  2  volts  and 
03  ohm  each  would  yield  in  the  same  case — 

44  volts 

, ~ , =  0.0175  ampere,  or  =  17-5 

(22    X    03)    +  2,500  ohms  /^        r  /  ^ 

milliamperes. 

In  order  to  obtain  17  milliamperes  with  2,500  ohms 
external  resistance,  we  should  therefore  require  50  cells 
of  I  volt  each,  whereas  the  same  result  would  be  obtained 
with  22  cells  of  2  volts  each  ;  and,  of  course,  with  the 
latter,  the  batteries  are  smaller  and  less  expensive  in  every 
way,  on  account  of  the  smaller  number  of  cells. 

The  cells  most  frequently  used  may  be  classified  in  two 
groups  :  Cells  which  contain  acids,  and  where  therefore 
the  zincs  have  to  be  taken  out  of  the  fluid  after  the  battery 
has  been  used — plunge  batteries  ;  and  cells,  the  exciting 
fluid  of  which  does  not  attack  the  zinc  as  long  as  the  circuit 
remains  open,  and  in  which,  consequently,  the  zinc  may 
remain  constantly  immersed  in  the  fluid. 


GALVANISM     AND     FARADISM 


163 


Fig.  64. — A  common 

form  of  Acid  Cell 

(Bichromate). 


Acid  Cells  for  Plunge  Batteries  present  practical  difficul- 
ties in  working  which  we  do  not  find  in  the  dry  cells.  They 
are  plunge  elements  {Figs.  64  and  65)  and 
the  vessels  cannot  be  hermetically  closed, 
nor  can  spilling  and  evaporation  be  entirely 
prevented,  though  the  use  of  specially 
shaped  vessels  and  rubber  floats  helps  to 
avoid  these  difficulties.  Then,  if  used 
regularly,  an  acid  cell  wants  cleaning  and 
refilling  once  every  three  months,  although 
the  refilling  is  a  fairly  simple  matter.  Such 
batteries  are  most  suited  for  occasional  use. 
They  have  a  high  E.M.F.  of  2  volts  and 
small  internal  resistance,  so  that  they  give 
about  30  per  cent  more  current  per  unit 
than  a  dry  Leclanche  cell. 

In  all  acid  cells  the  elements  are  carbon  and  zinc,  with 
solutions  of  varied  composition.  A  common  and  useful 
one  is  i  oz.  potassium  bichromate,  i  oz.  hydrarg.  bisulph., 
2  oz.  H2SO4  (strong),  and  a  pint  of  water.  The  zinc  lasts 
several  years  with  average  use,  and  can  be  replaced  without 
skilled  assistance. 

Constant  Immersion  in  which  there  is  no  Acid  Used. — 
Of  these  the  Leclanche  cell  is  used  more  than  all  other 
kinds  put  together.  For  galvanization  there  is  no  more 
reliable  and  convenient  cell  to  be  found.  The  size  of  the  cell 
must  not  however  be  reduced  too  much  for  the  mere 
sake  of  portability. 

The  E.M.F.  is  good  (1-5  volt),  and  the  internal  resistance 
is  moderate  (o'l  to  i  ohm),  according  to  the  size  of  the  cell. 
So  long  as  the  circuit  is  not  closed,  there  is  theoretically  no 
local  action,  and  practically  very  little.  It  is  always  ready 
for  use,  and  a  well-constructed  cell  will  last  for  two  3^ears 
without  having  to  be  seen  to  during  that  time.  Moreover, 
every  part  is  so  easily  accessible  that  the  cells  can  be 
cleaned  and  refilled  without  technical  aid.  In  order  to  clean 
Leclanche  cells,  the  crystals  which  stick  to  the  carbons 
and  zincs  have  to  be  scraped  off  with  a  knife,  carbon 
and  glasses  should  be  washed,  and  after  the  ceUs  have 
been  put  together  again,  they  are  refilled  with  a  saturated 
solution  of  pure  sal  ammoniac. 


16i 


NATURAL     THERAPY 


greatest 


With  Leclanche  cells,  as  with  most  others,  it  is  of  the 
importance  not  to  select  them  smaller  than  is 
absolutely  necessary,  for  the  smaller  they  are  made  the  less 
satisfactory  they  become.  Many  attempts  have  been  made 
to  construct  them  as  small  as  i  by  i  by  4  in.,  but  have  up 
to  the  present  time  invariably  failed.    The  constancy  of  such 


Fig.  65. — io-Cell  Bichromate  Battery. — This  battery  is  suitable  for  all  electric  lighting 
and  cautery  purposes ;  but  being  a  stationary  apparatus,  it  is  most  suitable  for  hospitals  or 
the  consulting-room.  Owing  to  the  large  surface  of  the  plates  and  the  capacity  of  the  cells, 
there  is  ample  reserve  of  power,  and  the  solution  will  last  from  6  to  12  months,  when 
in  constant  use,  without  recharging.  The  rack  action  at  the  side  allows  of  the  plates  being 
immersed  only  to  the  required  depth.  The  cells  should  be  entirely  lowered  when  the  battery 
is  out  of  use.  The  apparatus  is  fitted  with  a  rheostat,  by  which  a  certain  amount  of  resistance 
is  introduced  into  the  circuit,  and  can  be  gradually  reduced  to  the  required  point  suitable  for 
the  various  cautery  points  and  lighting  apparatus. 

small  Leclanche  cells  is  insufficient,  and  for  various  reasons 
the  local  action  is  greater  in  the  small  than  in  the  large  kind. 
Dry  Leclanche  Cells. — If  portability  has  to  be  con- 
sidered, the  dry  cells  belonging  to  the  Leclanche  type  {Fig.  66) 
have  great  advantage  over  the  cells  containing  fluid,  for 
there  is  no  liquid  to  be  spilled  or  to  corrode  the  brass  parts, 
and  there  is  no  glass,  etc.,  to  get  broken.     Their  internal 


GALVANISM    AND     FARADISM 


165 


66.— Dry  Cell. 


resistance  is  a  little  lower,  and  their  E.M.F.  a  little  higher, 
than  that  of  the  liquid  Leclanche  cells.  They  can  be  sent 
charged  all  over  the  world,  and  are  very  suitable  for  all 
batteries  which  have  to  be  frequently  carried 
about. 

Their  only  disadvantage  is  that  the  cells, 
after  being  exhausted,  cannot  be  recharged, 
but  have  to  be  replaced  by  new  ones,  and 
this  makes  the  refilling  rather  expensive. 
On  the  other  hand,  batteries  filled  with 
good  dry  cells  will  certainly  last  from  two  to 
four  years  without  requiring  recharging,  and 
they  are  less  likely  to  need  repairs  than  are 
those  filled  with  liquid,  because  accidents 
like  the  smashing  of  glasses  and  spilling  of 
corrosive  fluids  cannot  happen,  so  that  the 
difference  in  the  cost  of  maintaining  the 
batteries  is  not  quite  so  great  as  it  appears  at  first  sight. 
The  new  cells  can  be  sent  by  post,  and  can  easily  be 
inserted  in  the  place  of  the  old  ones,  so  that  the  battery 
itself  need  not  be  returned  to  the  maker. 

Number  of  Cells. — The  number  of  cells  a  battery  ought 
to  have  will  depend  on  the  purposes  for  which  it  is  required. 
Fifty  to  eighty  volts  are  necessary  for  diagnostic  purposes 
and  for  the  treatment  of  nervous  and  paralytic  diseases. 

In  addition  to  a  suitable  number  of  cells,  one  requires  to 
have  different  appliances  for  regulating  the  strength  of 
current,  for  interrupting,  reversing,  and  measuring  the 
current,  and  for  applying  it  to  the  body.  The  strength  of 
current  can  be  regulated  in  two  ways  :  either  by  varying 
the  E.M.F. ,  or  by  means  of  artificial  resistances.  The  first- 
mentioned  method  is  more  frequently  used,  and  is  managed 
by  means  of  a  current  collector. 

Current  Collectors. — These  are  used  to  increase  or 
diminish  the  number  of  cells  in  the  circuit,  thus  changing 
the  E.M.F.  and  regulating  the  strength  of  current.  They 
must  be  constructed  so  that  the  current  is  never  interrupted 
while  the  number  of  cells  is  being  changed,  as  this  causes 
disagreeable  shocks.  Further,  the  cells  should  be  put  in 
the  circuit  one  by  one,  not  five  by  five,  etc.,  as  this  will 
also  cause  shocks. 


166 


NATURAL     THERAPY 


Crank  Collectors  are  most  frequently  used.  A  number 
of  pegs,  equal  to  the  number  of  cells  in  the  battery,  are 
arranged  in  a  circle,  so  that  a  crank  can  be  brought  in 
contact  with  every  one  of  them  (Fig.  67).  The  cells  are  then 
connected  with  these  pegs  ;   a  wire  leads  from  the  first  zinc 

to  the  negative  terminal,  another 
wire  from  the  carbon  of  the  first 
cell  to  peg  I,  another  wire  from 
the  carbon  of  the  second  cell  to 
peg  2,  etc.,  and  one  wire  leads 
from  the  crank  to  the  positive 
terminal.  By  turning  the  crank 
the  number  of  cells  connected 
with  the  terminals  can  thus 
be  conveniently  increased  or  diminished.  In  order  to  avoid 
interrupting  the  current,  the  pegs  are  so  arranged  that  the 
crank  touches  the  next  peg  before  having  quite  left  the 
former  one. 

As  long,  however,  as  the  crank  touches  two  pegs — for 
instance  pegs  5  and  6  {Fig.  69) — at  the  same  time,  the 
sixth  cell  is  short-circuited,  for  the  current  can  pass  from 
the  zinc  of  cell  6,  which  is  connected  with  the  carbon  of 
cell  5,  on  to  peg  5  through  the  crank  of  peg  6,  and  from  thence 
back  to  the  carbon  of  cell  6,  without  finding  on  its  way  any 


Fig.  67. — Crank  Collector. 


Fig.  68. — Crank  rightly  placed. 

resistance  worth  mentioning.  If  this  state  of  affairs  lasts 
but  a  very  short  time,  it  causes  no  damage,  but  if  it  continue, 
the  short-circuited  cell  will  be  exhausted.  It  is  therefore 
important  with  all  crank  collectors,  to  let  the  crank  rest 
as  in  Fig.  68,  and  not  as  in  Fig.  69,  where  it  is  in  contact 
with  two  cells  at  once. 


GALVANISM     AND     FARADISM 


167 


The  number  next  to  the  peg  on  which  the  crank  rests 
shows  the  number  of  cells  in  action.  This  kind  of  collector 
is  convenient,  but  it  has  one  drawback,  especially  if 
used  with  batteries  containing  a  large  number  of  cells, 
viz.,  that  by  being  put  in  the  circuit,  the  first  cells  of  the 
batteries  are  exhausted  more  quickly  than  the  last  ones. 

Double  Collector. — This  is  designed  to  obviate  the  above 
difficulty,  and  has  two  cranks,  which  are  placed  on,  the 
same  axis,  but  are  insulated  from  one  another ;  the  zinc  of 


Kath(i(le 


Fig.  70. — Double  Crank  Collector. 


the  first  cell  is  not  connected  with  a  terminal,  but  with 
an  additional  peg  0.  One  crank  is  connected  with  the 
positive,  and  the  other  with  the  negative  terminal.  By 
these  two  cranks,  any  batch  of  cells  may  be  inserted, 
and  the  whole  battery  be  used  up  evenly.  fAn  index 
fitted  to  one  of  the  cranks  points  to  a  division,  thus 
showing  the  number  of  cells  in  action.  Finally,  each 
single  cell  can  be  connected  with  a  galvanometer  and 
tested,  so  that  damaged  or  exhausted  cells  may  be 
detected  without    trouble.     The   double   collector    is   thus 


168  NATURAL     THERAPY 

a  great  convenience  in  testing  a  battery,  and  is  certainly 
the  best  current  collector  known  at  the  present  time 
{Fig.  70). 

CURRENT   FROM   THE   MAIN. 

The  electric  current  for  lighting  houses  is  now  available 
in  most  towns,  and  even  in  some  country  districts.  It  is 
obviously  much  more  convenient  to  obtain  a  current  of 
perfect  constancy  by  merely  turning  a  switch,  than  to 
have  to  generate  it  in  primary  batteries  or  store  it  in 
accumulators.  The  transformers  or  rheostats  controlling 
the  current  require  no  charging  with  corrosive  liquids  ; 
most  of  them  are  not  even  subject  to  any  wear  and  tear, 
and  consequently  are  not  liable  to  get  out  of  order. 

There  are  two  kinds  of  current  used  for  lighting  houses, 
viz.,  the  continuous  and  the  alternating. 

Continuous  Currents. — In  some  towns  the  continuous 
or  low  tension  current  is  supplied.  The  E.M.F.  in  the 
street  mains  is  not  higher  than  that  which  is  used  in 
the  houses,  and  varies  from  100  to  250  volts  in  different 
towns.  A  battery  of  large  accumulators  is  nearly  always 
employed  in  connection  with  the  dynamos ;  during  the 
evening  the  current  is  supplied  directly  by  the  dynamos, 
but  during  part  of  the  daytime  by  the  accumulators. 
Heavy  copper  cables  are  required  to  distribute  such  a 
low  tension  current,  and  it  is  therefore  suitable  only  for 
thickly  populated  districts,  and  for  comparatively  short 
distances,  not  exceeding  one  and  a  half  miles. 

The  continuous  current  is  suitable  for  every  purpose  for 
which  electricity  may  be  employed  in  medicine,  such  as 
for  galvanization,  electrolysis,  and  faradization,  the  cautery 
and  motors.  X-ray  and  high-frequency  apparatus,  lamps 
for  treating  lupus,  electro-magnets,  etc. 

Alternating  Current. — In  other  towns,  and  in  many 
country  districts,  the  alternating  current  is  being  supplied. 
The  current  changes  its  direction  from  50  to  100  times 
every  second.  The  number  of  volts  and  amperes  of 
such  an  alternating  current  can  easily  be  raised  or 
lowered ;  a  high  voltage,  from  2,000  to  10,000  volts,  is  being 
used  in  the  mains,  but  on  entering  a  house  this  is  trans- 
formed down  to  200  or  100  volts  and  a  greater  number  of 


GALVANISM     AND     FARADISM 


169 


amperes,  making  it  suitable  for  incandescent  lamps,  etc. 
The  advantage  of  this  system  to  the  electric  lighting  com- 
panies lies  in  the  fact  that  the  copper  cables  emplo3'ed 
for  the  mains  need  be  only  one-tenth  to  one-hundredth 
part  of  the  thickness  required  for  the  distribution  of  the 
same  quantity  of  current  at  low  voltage. 

The  number  of  amperes  which  a  cable  can  carry  without 
becoming  hot  is  limited,  and  ought  not  to  exceed  i,ooo 
amperes  per  square  inch  (cross  section)  of  copper.  The 
number  of  volts,  however,  can  be  raised  as  far  as  the  safety 
of  the  insulation  will  permit  ;  as  many  as  30,000  volts  have 
alreadv  been  used  in  wires  suspended  on  porcelain  insulators 


Fig.  71. — Combined  Continuous  and  Alternating  Current  Switchboard. 


on  telegraph  poles,  and  sent  over  a  distance  of  more  than 
ioo"miles.  A  copper  cable  with  a  cross  section  of  one  square 
inch  can  carry  100,000  watts  only  with  100  volts,  but 
5,000,000  watts  with  5,000  volts.  The  net  gain  to  the 
■electric  light  company  is  not  nearly  as  great  as  these 
figures  imply,  because  with  cables  intended  for  5,000  volts  a 
much  better  insulation  is  necessary  than  for  200  volts 
•only  ;  moreover,  accumulators  cannot  be  used  with  the 
alternating  current,  and  the  engines  have  therefore  to 
run  all  day  long,  and  ultimately  there  is  some  constant 
loss  in  all  the  transformers  fixed  in  consumers'  houses 
as  long  as  no  current  is  being  used.  Nevertheless,  the 
alternating  current  requires  to   be   employed  whenever  it 


170  NATURAL     THERAPY 

is  to  be  sent  over  long  distances,  to  reduce  the  heavy- 
cost  of  copper  cables. 

The  alternating  tvpe  is  very  convenient  for  treatment 
with  sinusoidal  currents  ;  it  can  also  be  used  for  producing- 
X  rays  and  high-frequency  currents  (but  not  for  galvan- 
ization) by  means  of  Gaiffe's  or  Wright's  special  high- 
tension  transformer. 

Switchboard  for  High-Tension  Transformer. — For  the 
continuous  as  well  as  for  the  alternating  current  it  is 
necessary  to  employ  a  rheostat,  or  a  transformer  of  some 
kind  {Fig.  71),  to  control  the  current's  strength,  or  to  reduce 
the  voltage,  etc.,  in  order  to  protect  the  patient  or  the 
apparatus  from  overdoses  or  dangerous  currents. 

Rheostats. — Batteries    provided    with    a    good    current 

collector    need   no    rheostat    as    a   rule,    though   such    an 

appliance  may  be  wanted.     Rheostats  may  be  used  instead 

of    the    current    collector   as   a  means  of    regulating  the 

strength  of  the  current.     In  order  to  reduce  the  current 

of  a  battery  of  45  volts  to  about  a  half  milliampere,  the 

resistance  required  would  be,  according  to  Ohm's  law  : — 

4S  volts  1 

— ^^ =  00,000  ohms, 

0-0005  ampere 

and  it  should  be  possible  to  diminish  this  resistance 
gradually,  in  order  to  avoid  all  shocks  in  increasing  the 
currents. 

Liquid  Rheostats. — These  have  the  advantage  of  cheap- 
ness. They  consist  generally  of  a  glass  tube,  the  lower  end. 
of  which  is  closed  with  a  piece  of  platinum,  which  acts  as- 
one  electrode.  The  second  electrode  is  a  piece  of  zinc,, 
which  may  be  moved  up  and  down  in  the  glass  tube.  If 
the  tube  is  filled  with  some  badly-conducting  liquid,  and 
the  piece  of  zinc  is  drawn  out  as  far  as  possible,  the  resistance- 
is  greatest.  The  number  of  ohms  depends  on  the  length 
of  the  tube,  the  diameter  of  the  electrode,  and  the  conducting: 
capacity  of  the  liquid.  The  resistance  is  diminished 
by  moving  the  zinc  downwards.  As  decomposition  must 
take  place  in  these  rheostats,  small  gas  bubbles  form 
on  the  electrodes,  changing  the  surface  of  the  electrodes, 
and  the  resistance  continually.  In  order  to  prevent  this, 
a  depolarizing  substance — for  instance,  chloride  of  zinc — 
is  mixed  with  the  water.     A  weak  solution  of  chloride  of 


GALVANISM    AND     FARADISM 


171 


zinc,  however,  depolarizes  but  a  little,  and  would  therefore 
only  prevent  the  gas  bubbles  with  very  weak  currents  ; 
but  a  strong  solution  of  chloride  of  zinc  conducts  pretty 
well,  and  in  order  to  obtain  a  high  resistance,  the  glass 
tube  would  have  to  be  very  long,  an  arrangement  which 
is  impracticable  with  portable  batteries.  On  account  of 
these  difficulties,  the  use  of  liquid  rheostats  will  always  be 
limited. 

Metal  Rheostats. — These  are  generally  employed.     They 
alone   are   suitable    for   measuring   purposes,   as    they  are 


Figs.  72,  73. — Metal  Rheostats. 

the  most  accurate  and  the  least  subject  to  changes 
{Figs.  72,  73).  The  instruments  for  medical  purposes  are 
provided  with  a  crank  like  the  current  collectors  ;  each 
peg  is  connected  with  its  neighbours  by  long  and  fine 
German  silver  wire,  through  which  the  current  has  to  pass 
till  it  reaches  the  peg  on  which  the  crank  rests.  In  order 
to  obtain  high  resistances  without  making  the  number  of 
ohms  between  the  various  pegs  too  great,  a  good  many 
pegs  are  necessary.  As  a  rule,  several  crank  rheostats  are 
so  arranged  that  the  first  increases  the  number  of  ohms, 


172 


NATURAL    THERAPY 


10  by  10,  up  to  say  200  ohms  ;  the  second,  100  by  100,  up 
to  2,000,  etc.  Such  rheostats,  though  convenient,  are 
rather  costly,  and  they  are  as  a  rule  only  used  for  the  more 
expensive  office  batteries. 

Graphite  Rheostats.  —  Convenient  and  inexpensive 
rheostats  of  low  or  high  resistances  may  be  made  of  graphite, 
and  they  can  be  so  arranged  that  the  current  may  be  varied 

without  giving  any  shocks.  The 
only  disadvantage  of  graphite 
rheostats  is  that  the  conducting 
capacity  of  the  graphite  varies  ; 
this  makes  them  quite  unfit  for 
measuring  purposes,  but  is  of  no 
importance  for  rheostats  required 
only  for  regulating  the  strength 
of  currents,  and  certainly  the 
graphite  rheostats  are  up  to  now 
the  most  suitable  resistances  for 
portable  batteries.  They  are  best 
made  of  lead  pencils  ;  the  length 
which  the  current  has  to  pass 
through  can  be  varied  conve- 
niently by  a  sliding  spring  on  the 
pencils.  Dr.  Herschell  recommends 
the  Bailey  Rheostat  made  by  the  Law  Battery  Company, 
U.S.A. 

High-Tension  Transformer.  —  A  transformer  consists 
essentially  of  a  closed  iron  circuit,  and  a  primary,  secondary 
and  safety  winding,  and  is  used  to  produce  high-tension 
impulse  with  small  consumption  of  primary  current.  A 
transformer  is  capable  cf  withstanding  any  ordinary  tension 
which  it  may  be  put  to,  and  provided  the  apparatus  is  used 
properly,  and  there  is  no  sudden  reversal  of  current,  for 
instance,  there  is  no  danger  of  the  insulation  giving  way 
{Fig.  75).  The  secondary  circuit  being  open,  the  tension 
manifests  itself  by  a  stream  of  sparks  between  the  secondary, 
terminals,  which  vary  in  length  up  to  300  mm.  These 
instruments  are  mounted  on  a  carrier,  and  have  terminals 
provided  for  primary,  secondary,  and  low-tension  windings. 
In  conjunction  with  the  instrument  are  used  a  choking  coil 
and  rheostat,  and  by  means  of  the  latter  the  capacity  given 


Series  Resistance 


GALVANISM    AND     FARADISM 


173 


off  the  high  tension  inside  of  the  transformer  is  controlled 
and  reduced  to  a  usable  condition,  so  that  the  tension  does 
not  strike  an  arc,  but  manifests  itself  in  a  continuous 
stream  of  sparks. 


-High-Tension  Transformer. 


Motor  Transformers. — If  a  motor  driven  by  the  current 
from  the  main  is  coupled  with  a  dynamo,  we  can  produce 
currents  of  another  type,  or  another  voltage  or  amperage. 


Fig.   76. — Motor  Transformer. 


according  to  the  dynamo  chosen.  Such  combinations  are 
called  motor  transformers  {Fig.  76).  They  are  used  for  a  great 
variety  of  purposes  ;  in  some  cases  an  existing  alternating 
current  has   to   be   converted   into   a   continuous   current. 


174  NATURAL     THERAPY 

because  the  latter  is  better  for  a  spark  coil,  or  an  arc  lamp 
for  treating  lupus.  In  other  cases  an  existing  continuous 
current  may  have  to  be  converted  into  an  alternating 
current,  either  to  obtain  sinusoidal  currents,  or  for  trans- 
formers for  high-frequency  currents.  Ultimately,  the 
voltage  of  a  continuous  current  may  have  to  be  reduced 
to  make  it  suitable  for  arc  lamps,  or  for  charging 
accumulators  ;  or  else  the  current  may  have  to  be  trans- 
formed as  a  measure  of  precaution,  to  make  the  current 
applied  in  a  bath  independent  of  the  main  and  of  leakages, 
and  thus  avoid  all  possibility  of  shocks. 

The  Safety  of  using  Currents  from  the  Main. — If  a  shunt 
rheostat  and  lamp,  as  described  below,  be  used,  it  is  scarcely 
possible  for  the  patient  to  receive  too  powerful  a  current, 
that  is  a  dangerous  shock.  Of  course  the  current  may 
be  turned  on  by  mistake  while  the  spring  of  the  rheo- 
stat is  "strong"  instead  of  "weak,"  just  as  this  can 
happen  while  the  current  collector  of  the  battery  is  still 
full  on.  In  both  instances  a  very  unpleasant  but  not 
dangerous  shock  will  be  given.  With  the  usual  system 
of  underground  cables,  the  E.M.F.  of  a  continuous  current 
never  rises  suddenly  to  dangerous  proportions. 

In  most  installations,  however,  owing  to  defective 
insulation,  there  is  a  certain  amount  of  leakage  or  escape 
of  electricity  to  earth  {Fig.  yy).  If  the  three-wire  system 
be  used,  and  the  positive  pole  of  the  dynamo  is  connected 
with  earth,  a  patient,  also  in  good  earth  contact,  may 
receive  a  shock  when  the  electrode  is  applied,  even  if  there 
is  ample  resistance,  or  if  this  electrode  happens  to  be 
connected  with  the  negative  pole  of  the  dynamo.  Such 
shocks  practically  never  occur,  owing  to  patients  being 
usually  well  insulated  from  the  earth  by  a  carpet  or  dry 
wooden  floor.  Operators  have  received  unpleasant  shocks 
from  holding  an  electrode  in  one  hand,  while  they  attempted 
with  the  other  to  open  a  water  tap  to  moisten  the  electrodes. 
It  must  be  made  a  rule  not  on  any  account  to  touch  gas  or 
water  pipes  so  long  as  one  hand  is  in  contact  with  the 
switchboard  or  an  electrode.  There  is  really  no  danger  in 
iocal  applications  of  the  current  if  this  rule  is  adhered  to. 

The  case  is,   however,  different  if  the  current  is  to  be 
applied  in  a  bath.     A  patient  might  receive  even  a  fatal 


GALVANISM    AND     FARADISM 


175 


shock  if  the  necessar}^  precautions  are  neglected.  The 
water  in  a  bath  tub,  even  if  the  latter  is  made  of  porcelain, 
is  usually  in  excellent  contact  with  the  earth  through  the 
waste-pipes,  etc.,  which  are  of  metal.  If  the  current  is 
intended  to  be  applied  in  a  bath,  it  is  necessary  to  insulate 
the  water  by  replacing  the  metallic  waste-pipes  by  others 


Bafh 


idle  (~)poIc 


"  " "  -^ wcLsfe.  tfipe  forminff 
°"^-''  earTh  connecffon 


Waste  Pipe 


Fig.  77. — Scheme  of  Electric  Bath  Circuit  to  show  how  short-circuiting  may  take 
place  by  means  of  the  earth  contact  with  waste  pipe. 

made  of  earthenware  for  a  considerable  distance  :   or  better, 

to  let   the  bath    discharge   pipe  run   into    an   open   gully 

connected  with  a  main  waste  pipe  {Fig.  78) ;    by  enclosing 

the  inlet  pipes  and  taps  in  wooden  cases,  so  that  a  patient 

cannot   possibly   touch   them  ;    and   by   using  a   bath  tub 

made    of    porcelain    or    wood. 

If    this    cannot    be    done,    the 

metal  bath  tub  must   at  least 

be   placed   on    porcelain    tiles. 

If  the  leakage  is  bad,  or  if  one 

pole  of  the  mains  is  earthed, 

there     should    be    no    current 

reverser    on    the    switchboard. 

If   the  current   is  used  for  an 

electric  bath  in  a  hospital  or  hydropathic,  it  is  advisable 

to  transform  the  current  by  means  of  an  electric  motor 

driving  a  small  dynamo,  which  affords  effectual  protection 

against  shocks. 

The  above  remarks  apply  to  the  full  hydro-electric  bath  ; 
if  the  current  is  applied  in  small  local  baths  to  feet  or  arms. 


maferisl ' 


Fig.  78. 


176 


NATURAL     THERAPY 


as,  for  instance  in  the  Schnee  4-cell  bath,  there  is  no  danger 
at  all,  because  small  earthenware  or  glass  vessels  are 
usually  employed,  which  are  not  connected  with  the  earth 
by  waste-pipes. 

Switchboard    for    Galvanization. — In    order    to    control 
current  from  the  main  for  galvanization  and  electrolysis. 


Fig.  79. — Switchboard  for  Galvanization,  Electrolysis,  and  Faradization,  consisting  oJ 
Volt  Selector  to  vary  the  current  from  the  main  fromlp'i  volt  gradually  up  to  about  70  volts; 
Sledge  Coil,  Galvanometer  with  two  shunts  ;  CurrentReverser  and  Dr.  de  Watteville's  Key, 

a  special  shunt  rheostat  or  volt  selector  is  used  {Fig.  79). 
It  consists  of  a  slate  core  round  which  about  500  turns  of 
fine  platinoid  wire  are  wound  ;  the  single  turns  are  quite 
close  together,  but  insulated  from  one  another.     The  total 


GALVANISM    AND     FARADISM 


177 


resistance  is  over  500  ohms.  An  incandescent  lamp  of 
15  to  32  C.P.,  or  preferably  two  lamps  in  parallel,  are  also 
inserted  in  the  circuit,  partly  as  a  safety  resistance  to  protect 
the  patient  against  an  overdose,  partly  to  increase  the  total 
resistance,  so  that  the  fine  platinoid  wire  cannot  be  over- 
heated. Moreover,  the  lamp  bums  with  a  dull  red  light  as 
long  as  the  switch  is  turned  on,  whether  the  electrodes  are 
connected  or  not,  and  thus  acts  as  a  signal  to  the  operator 
to  turn  the  current  off  when  the  application  is  over. 

If  the  sliding  spring  is  on  the  rightrhand  near  B, 
the  E.M.F.  between  the  terminals  leading  to  the  patient  is 
only  a  small  fraction  of  a  volt.  As  we  move  the  spring 
towards  the  left,   the   E.M.F.   available  at  the  terminals 


Ftg.  80. — Diagram  of  Switchboard  with  I,amp  and  Wire  Resistance. 

will  increase,  but  only  very  gradually.  A  galvanometer 
should  always  be  used  with  these  apparatus.  The  number 
of  cells  in  a  battery  is  some  sort  of  guide  to  current 
strength  ;  but  with  loo-volt  current  from  the  main  it  is 
dangerous  to  dispense  with  a  galvanometer. 

Galvanometers. — By  means  of  these  delicate  instruments 
{Fig.  81)  the  current  strength  is  estimated  while  passing 
through  the  patient,  and  the  physician  is  in  a  position  to 
accurately  graduate  the  dose,  with  different  batteries  and 
with  patients  of  different  degrees  of  sensibility  and  resistance. 
For  their  introduction  we  are  chiefly  indebted  to  Edelmann 
and  von  Ziemssen. 

Galvanometers  may  be  vertical  or  horizontal.  It  is 
easier  to  read  a  vertical  instrument,  but  the}^  are  not  so 

12 


178 


NATURAL    THERAPY 


reliable  as  the  horizontal  type,  owing  to  changes  which  take 
place  in  the  magnetism  of  the  needles.  Following  these 
alterations,  so  also  do  the  directing  influences  of  the 
terrestrial  magnetism  and  of  the  current  change  in  the 
same  proportion.  Horizontal  galvanometers  are  therefore 
generally  to  be  preferred. 

Suspension  of  the  Magnet. — The 
inertia  is  least  in  the  case  of 
instruments  the  magnet  of  which 
is  suspended  on  a  cocoon  fibre, 
and  in  this  case  the  friction  also 
remains  the  same.  Such  instru- 
ments have  therefore  the  great 
advantage  that  if  their  graduation 
be  correct  for  a  certain  locality, 
this  graduation  will  always  remain 
correct  and  reliable.  These  are 
no  doubt  the  most  sensitive 
instruments,  as  currents  up  to 
tVth,  or  even  iFo^h  of  a  milliampere  can  be  measured. 
In  all  cases  where  perfect  accuracy  is  required,  only  such 
apparatus  should  be  used.  As  these  instruments  are  some- 
what delicate  and  expensive,  portable  batteries  are  now 
provided  with  galvanometers,  the  magnets  of  which  are 
suspended  on   a  steel  point,  as  in  a  compass.      Ordinary 


Fig.  8i. 
The  d'Arsonval  Galvanometer. 


Fig.  82 — Combined  Electrode  Holder  and  Galvanometer. 


sewing-needles  are  used  for  this  purpose,  since  they  are 
easily  replaced  by  new  ones,  in  order  to  keep  them  sharp 
and  the  instrument  sensitive. 

The  dArsonval  galvanometers  are  so  constructed  as  to 
work  in  any  position  with  accuracy.  They  are  provided 
with    a    movable    horse-shoe    magnet,   which    is    deflected 


GALVANISM  AND  FARADISM    179 

from  its  direction  toward  the  north  pole  by  an  electrical 
current  circulating  in  its  neighbourhood.  Kelvin  suggested 
replacing  this  permanent  magnet  by  a  solenoid,  and  other 
scientists  made  practical  use  of  the  idea.  Many  turns 
of  a  fine  insulated  wire  are  bound  on  a  frame  of  aluminium, 
which  is  suspended  between  two  points  so  that  it  can  move 
freely.  Two  hair-springs  keep  the  frame  in  a  certain 
position,  and  at  the  same  time  conduct  the  current  to  the 
solenoid.  As  long  as  a  current  passes  through  the  solenoid, 
it  is  attracted  or  repelled,  according  to  the  polarity,  by  a 
current  circulating  in  the  neighbourhood,  and  the  elasticity 
of  the  hair-springs  is  the  power  which  has  to  be  overcome, 
and  which  brings  the  frame  back  to  its  original  position 
as  soon  as  the  current  ceases.  These  galvanometers  are 
therefore  quite  independent  of  the  terrestrial  magnetism, 
and  can  be  used  in  horizontal,  vertical,  or  any  other  position  ; 
moreover,  they  are  protected  by  a  horse-shoe  magnet, 
which  acts  as  a  screen  against  disturbing  influences  from 
outside.  The  galvanometers  with  a  magnet  dependent  on  the 
north  pole  are  so  much  influenced  by  the  current  supplied 
for  lighting  houses,  that  it  is  impossible  to  take  exact 
measurements  in  houses  lit  by  electricity,  whereas  these 
new  galvanometers  remain  correct  even  near  dynamos. 

These  advantages  render  the  dArsonval  galvanometers 
specially  useful  for  all  apparatus  utilizing  currents  from 
the  main ;  they  are,  however,  equally  convenient  for 
batteries,  their  only  drawback  being  that  the  hair-springs 
are  easily  damaged  if  too  strong  a  current  is  sent  through 
the  galvanometer. 

Shunt. — All  medical  galvanometers  are  divided  into 
milliamperes.  In  order  to  be  able  to  measure  weak  currents 
for  galvanization,  as  well  as  strong  currents  for  electrolysis, 
with  the  same  instrument,  most  galvanometers  are  fitted 
with  a  shunt,  which  can  easily  be  switched  on  and  off.  So 
long  as  this  shunt  is  not  used,  the  whole  current  has  to 
pass  through  a  long  fine  wire,  which  is  arranged  to  make 
the  magnet  decline  from  the  magnetic  meridian.  If, 
however,  the  shunt  is  brought  into  action,  by  screwing 
home  a  screw  marked  X  {Fig.  83)  the  current  finds  another 
passage  through  a  short  and  thicker  wire,  which  is  wound 
so  as  not  to  influence  the  magnet,   and  in  this  way,  two 


180 


NATURAL    THERAPY 


Plan  of  Shunt  Circuits  of  a  Galvanometer. 


paths  being  open  to  the  current,  it  will  divide  itself  among 
both,  so  that  its  strength  in  each  branch  is  inversely 
proportional  to  the  resistance  of  the  wire.  If,  for  instance, 
the  shunt  wire  is  chosen  so  that  its  resistance  is  tVfh  of 
the  resistance  of  that  wire  which  makes  the  needle  decline, 

only  yVth  of  the  current  will 
flow  through  the  latter  wire, 
and  Toths  through  the  shunt 
wire.  The  magnet,  there- 
fore, will  be  influenced  by 
only  yVth  of  the  current 
which  actually  passes  through 
the  galvanometer  ;  and  con- 
sequently the  numbers  in- 
dicated on  the  dial  have  to 
be  multiplied  by  lo  in  order 
to  find  the  real  strength  of 
the  current.  A  galvano- 
meter, for  instance,  which, 
without  the  shunt,  indicates 
up  to  25  milliamperes  one  by  one,  will,  if  the  shunt 
is  used,  show  up  to  250  milliamperes  10  by  10.  The 
resistance  of  the  shunt  can  also  be  so  arranged  that  the 
numbers  on  the  dial  have  to  be  multiplied  by  100. 

Voltmeter.  —  If  the  resistance 
has  been  increased  up  to  1,000 
ohms,  a  milliamperemeter  can  be 
used  for  measuring  the  E.M.F. ; 
for  as  a  current  of  i  volt  produces 
I  milliampere  in  1,000  ohms,  the 
number  of  milliamperes  is  equal  to 
the  number  of  volts  as  long  as 
the  resistance  in  the  circuit  is 
1,000  ohms.  The  body  of  a 
patient,  or  any  other  unknown 
resistance,  must  not  therefore  be 
in  the  circuit  while  the  E.M.F.  of 
the  cells  is  being  measured. 

If  the  strength  of  current  obtained  through  a  patient  is 
known,  and  the  E.M.F.  of  the  cells  which  has  been  used 
to  produce  the  above  strength  has  been  measured  in  volts 


/■  1^.  hj.  — \'<iltmctcr. 


GALVANISM    AND     FARADISM 


181 


in  the  way  just  mentioned,  the  resistance  of  the  patient 
can  be  ascertained  with  the  formula  : — 


E.M.F. 


=  Resistance. 


Current 

A  galvanometer,  the  sensitiveness  of  which  has  been 
reduced  by  screwing  home  the  shunt,  is  of  course  insensible 
to  weak  currents  ;  on  the  other  hand,  however,  a  single 
cell  is  insufficient  to  deflect  the  needle  of  the  galvanometer 
to  a  right  angle  as  long  as  there  is  not  the  resistance  of  a 
patient  in  the  circuit. 

Current  Reversers  and  Combiners. — It  is  important  for 
most  physicians  to  possess  an  arrangement  which  makes  it 
possible  suddenly  to  close  or  interrupt  the  current,  or  else 
suddenly  to  connect  with  the  negative  pole  the  electrode 
hitherto  connected  with  the  positive  pole,  and  vice  versa. 
These  sudden  changes  produce  contractions  of  the  muscles, 
the  intensity  of  which  depends  on  the  strength  of  the 
current  and  the  sensitiveness  and  healthiness  of  the  muscle. 
They  are  therefore  very  important  for 
diagnosis.  To  interrupt  and  to  reverse 
the  current  can  be  managed  with  a 
single  instrument,  of  which  we  give  a 
diagram  {Fig.  85).  The  negative  pole 
of  the  battery  is  connected  with  R  and 
N,  the  positive  pole  with  the  metal 
piece  between  these  two.  While  the 
cranks  point  towards  N  (normal),  as  in 
the  illustration,  the  right-hand  crank  is 
connected  with  the  negative  pole,  and 
the  left-hand  crank  with  the  positive. 
By  moving  the  cranks  slightly  to 
they  rest  on  R  and  N,  both  cranks  are  in  contact 
with  the  negative  pole,  consequently  there  is  no  current 
at  all ;  but  if  we  move  the  cranks  farther,  so  that 
they  point  towards  R,  the  left-hand  crank  is  connected 
with  the  negative,  and  the  right-hand  crank  with  the 
positive  pole.  From  each  crank  a  wire  leads  to  a 
terminal    screw. 

Current  reversers  are  manufactured  in  many  shapes,  but 
in  principle  their  construction  is  always  the  same. 


Fig.  85 — Current  Reverser. 

the    left,    so    that 


182  NATURAL     THERAPY 

Current  Alternator  and  Combiner. — In  order  to  be  able 
to  change  the  continuous  or  the  faradic  current  suddenly, 
without  having  to  connect  the  electrodes  with  other 
terminals,  and  in  order  to  be  able  to  apply  at  the  same  time 
continuous  and  faradic  currents  combined.  Dr.  de  Watteville 
has  suggested  a  convenient  apparatus,  which  outwardly 
resembles  a  current  reverser  {Fig.  86). 
While  the  cranks  point  to  G,  the 
galvanic  current  is  connected  with 
the  terminals  ;  while  the  cranks  point 
to  F,  the  faradic  current  is  connected 
with  the  terminals  ;  and  while  they 
stand  half  way  (G  F),  the  galvanic 
and  faradic  currents  are  connected 
with  each  other  in  series,  i.e.,  the 
^^^' ^'■^t^rnat'or"''"'''  coutinuous  currcut  has  to  pass 
through  the  bobbin  of  the  induction 
coil  and  the  patient,  and  the  faradic  current  has  to  pass 
through  the  patient  and  all  the  cells  of  the  continuous 
current  battery.  Thus  both  currents  pass  through  the 
patient  at  the  same  time. 

Electrodes. — The  various  sizes  and  shapes  are  well  known. 
Care  should  be  taken  that  there  is  no  hole  in  the  chamois 
covering  permitting  contact  of  the  metal  with  the  patient's 
skin,  as  this  would  be  painful,  and  even  cause  sores  to  break 
out.  With  plate  electrodes  a  frequent  fault  is  not  to  have 
them  large  enough.  Dr.  Herschell  prefers  sponge  electrodes 
{Fig.  87)  on  a  wooden  cup  base  for  galvanism,  in  place  of 
the  metal  with  leather  cover. 

Handles. — The  handles  are  provided  with  a  terminal 
for  the  reception  of  a  connecting  cord,  and  with  a  thread 
fitting  the  electrodes.  They  are  also  provided  with  an 
insulating  handle,  so  that  the  physician  holding  them  is 
not  exposed  to  the  action  of  the  current.  Many  handles 
are  provided  with  a  trigger,  for  making  or  breaking  the 
current  ;  this  can  be  conveniently  managed  on  the 
handles  with  one  finger  only,  whereas  the  hand  is 
required  to  work  an  interrupter  on  the  battery.  There 
are  also  handles  which  contain  a  current  reverser  or  a 
rheostat  ;  but  they  are  complicated,  and  are  rarely  of  real 
advantage. 


GALVANISM  AND  FARADISM    183 


Fii:.  ■)! 
Figs.  87  to  91. — Various  forms  of  Electrodes. 

Cords. — Two  connecting  cords  of  suitable  length,  covered 
with  some  insulating  material,  are  necessary  for  conducting 
the   current  from  the  batter}-  to   the   patient.     Insulated 


184  NATURAL     THERAPY 

copper  wire,  which  is  bare  for  half  an  inch  at  both  ends, 
is  sufficient ;  but,  on  account  of  the  greater  fiexibihty, 
cords  made  of  about  twelve  very  fine  wires,  terminating  at 
both  ends  in  short  and  thick  wires,  are  mostly  used.  These 
are  fastened  in  the  handles  and  in  the  terminals  of  the 
battery.  The  short  wires  should  not  be  soldered  on  to  the 
cords,  as  soldered  parts  stand  no  bending, — a  ball  and 
socket  joint  is  best.  Cords  may  be  insulated  by  means  of 
silk,  or  cotton  or  indiarubber  may  be  used,  but  these  soon 
perish.     The  silk-covered  cords  last  a  long  time. 

Density  of  the  Current. — The  size  of  the  electrodes  is  of 
considerable  importance.  The  larger  the  electrode,  the 
smaller  the  resistance  of  the  human  body.  Electrodes 
of  ten  square  inches  surface  will  pass  through  the  body 
twice  the  current  that  can  be  conveyed  by  five  square 
inches  under  otherwise  equal  conditions.  This  leads  us 
to  the  density  of  the  current,  or,  in  other  words,  the 
proportion  of  the  strength  of  current  to  the  sectional 
area  of  the  conductor.  If,  for  instance,  with  electrodes 
of  three  square  inches  surface  20  milliamperes  are  passing 
through  the  body,  the  current  is  three  times  as  dense  as  if 
electrodes  of  nine  square  inches  and  the  same  strength  of 
current  were  used.  In  other  words,  in  the  first  case  each 
square  inch  of  the  places  of  application  receives  6-6 
milliamperes,  whereas  in  the  second  case  only  2 '2  milliam- 
peres are  received  by  the  same  area.  The  physiological 
and  chemical  effects  would  in  the  first  case  be  three  times 
as  strong  at  and  near  the  point  to  which  we  apply  the 
electrode  as  in  the  second  case.  Statements  that  such  and 
such  results  have  been  obtained  with  so  many  milliamperes 
are  therefore  incomplete  unless  the  diameter  of  the 
electrodes  used,  and  the  time  of  application,  are  mentioned 
as  well.  On  entering  the  body  the  current  divides  itself 
into  numerous  loops  and  branches,  and  follows  the  best 
conducting  parts  till  it  reaches  the  other  electrode.  The 
density  is  greatest  where  the  two  electrodes  touch  the  body  ; 
it  is  a  little  less  near  the  straight  line  connecting  the  two 
electrodes,  and  smallest  in  those  parts  of  the  body  which 
are  most  distant  from  the  electrodes  ;  but  experiment 
shows  that  even  those  parts  are  reached  by  some  small 
part  of  the  current. 


GALVANISM  AND  FARADISM    185 

The  effect  of  the  current  is  frequently  desired  in  one 
definite  spot  only,  but  as  we  necessarily  require  two 
electrodes  to  complete  the  circuit,  they  are  chosen  of  very 
different  diameter  :  a  small  one  (active  electrode)  to  con- 
centrate the  current  on  the  nerve  or  muscle,  etc.,  which 
is  to  be  influenced  by  the  current,  and  a  large  one  (called 
the  indifferent  electrode)  which  may  be  applied  to  the 
hands  or  any  easily  accessible  part  of  the  body.  If  the 
latter  electrode  is  chosen  sufficiently  large,  undesirable 
effects,  such  as  pain  or  blisters,  etc.,  will  be  avoided. 

Faults  in  a  Battery. — If  a  battery  does  not  work,  it  is 
essential  to  ascertain  where  the  fault  is  :  whether  in  the 
cells,  in  the  connection  between  the  cells  and  the  terminals, 
or  in  the  cords,  handles,  etc.  The  fault  will  most  frequently 
be  found  in  the  connecting  cords.  They  are  liable  to  break, 
and  this  shows  itself  by  their  too  great  flexibility ;  they 
should  be  cut  off  at  the  defective  point.  In  all  batteries 
with  a  great  number  of  elements,  a  spark  appears  if  the 
two  ends  of  the  connecting  cords  are  brought  in  contact 
and  separated  again.  If  no  spark  is  seen,  fasten  one  end 
of  a  cord  to  a  terminal,  and  touch  with  the  other  end  the 
other  terminal.  If  still  no  spark  is  visible,  touch  the  first 
peg  with  one  end  of  a  cord,  and  with  the  other  end  touch 
the  last  peg  of  the  collector,  and  if  there  is  still  no  spark, 
try  with  groups  of,  say,  five  elements  each,  either  on  the 
pegs  of  the  current  collector  or  directly  on  the  terminals 
of  the  cells.  If  the  elements  are  not  very  old,  a  spark  will 
be  obtained  from  several  of  these  groups,  and  the  faulty 
cells  may  be  singled  out.  A  whole  battery  may  fail 
because  one  of  the  many  screws  on  the  cells  may  have 
become  loose,  on  account  of  differences  of  temperature  or 
shaking  in  transit,  for  a  loose  screw  makes  no  contact 
with  the  wire  which  connects  one  cell  with  the  next. 
This  can  easily  be  rectified  by  tightening  the  screw. 
Another  reason  may  be,  that  in  consequence  of  short 
circuit  (caused  by  a  wrong  position  of  the  current  collector, 
or  by  a  fault  in  the  cell),  a  zinc  is  eaten  through,  or  the 
fluid  has  escaped  through  a  crack  in  the  element  vessel. 
In  both  cases  the  connection  is  interrupted,  and  the 
defective  cell  or  cells  must  be  removed  and  refilled,  or 
replaced  by  new  ones  ;    if  this  is  impossible  at  the  time. 


186  NATURAL    THERAPY 

the  last  cells  of  the  battery  may  be  taken  off  and  put  in 
place  of  those  which  are  defective  until  new  can  be  obtained. 
(Batteries  which  are  so  constructed  that  each  single  cell 
can  be  taken  out,  are  for  this  reason  much  better  than 
those  in  which  the  cells  are  soldered  together,  or  other- 
wise inaccessible  ;  for  if  one  cell  in  the  latter  goes  wrong, 
the  whole  battery  has  to  be  returned  to  the  maker).  A 
galvanometer  greatly  helps  to  locate  such  a  fault  :  the 
cords  are  connected  with  the  galvanometer,  and  the  other 
ends  are  placed  first  on  pegs  i  and  2,  then  on  2  and  3,  etc.  ; 
in  this  way  each  cell  can  be  tested  and  any  fault  detected. 
In  batteries  provided  with  a  double  collector  it  is  simpler 
still.  If  two  wires  connected  with  the  cell  be  applied  to 
the  tongue  of  the  operator,  a  peculiar  taste  is  felt  while  the 
cell  is  working.  This  method,  however,  is  dangerous  if 
the  battery  contains  more  than  ten  cells. 

It  is  rare  that  a  fault  occurs  in  the  connections  between 
the  cells  and  the  current  collector,  the  wires  being  mostly 
well  protected  and  all  the  invisible  connections  being 
soldered.  The  pegs  of  the  current  collector,  as  well  as  the 
current  reverser,  are  liable  to  get  oxidized,  especially  in  acid 
batteries,  and  have  to  be  cleaned  occasionally  with  fine 
emery  paper  ;  dust  between  the  pegs  should  be  removed 
with  a  fine  hair  brush.  The  screws  which  keep  the  cranks 
of  the  current  collector  and  reverser  on  their  axes  may  work 
loose,  and  have  to  be  tightened.  The  handles  with  an 
interrupter  may  fail  to  make  contact  through  oxidation, 
or  through  the  spring  being  loose.  Cords,  handles,  or  wet 
electrodes  ought  never  to  he  placed  on  the  current  collector, 
etc.,  as  they  may  cause  short  circuit. 

GENERAL  TECHNIQUE  OF  GALVANIZATION. 

The  Galvanic  Current  may  be  employed  locally  or 
generally.  The  application  may  be  (i)  stabile  or  (2)  labile. 
In  the  first  method  the  electrode  is  kept  in  one  position 
throughout  the  apphcation.  In  the  second  it  is  moved 
about  over  the  area  to  be  treated,  without,  however, 
breaking  contact.  The  active  electrode  may  be  anode  or 
cathode,  according  to  circumstances. 

General  Galvanization. — The  patient  is  completely 
stripped,  and  lies  on  a  couch  with  bare  feet  in  contact  with 


GALVANISM    AND     FARADISM 


187 


a  large  covered  electrode,  which  is  as  usual  moistened  with 
a  little  warm  vinegar  and  water  or  saline  ;  alternatively, 
the  patient  may  sit  upon  a  chair  and  place  his  feet  in  a  basin 
of  warm  water  in  which  lies  the  cathode. 

The  anode  is  then  rapidly  passed  over  the  surface  of  the 
patient's  body,  commencing  with  the  head,  then  the  back, 
spine,  trunk,  and  limbs. 

The  current  strength  will  vary  from  one  to  two  milliam- 
peres  for  the  head,  up  to  eight  or  ten  for  the  rest  of  the 
body.  Generally,  galvanism  is  only  so  employed  for  ex- 
ceptional cases,  being  more  commonly  used  in  the  form 
of  the   galvanic   bath   {q.  v.). 


Fis-  92. — Galvanic  Battery  with  CuUcclur  and  Ci-nunuitalor. 

Central  Galvanization — The  patient  is  stripped  to  the 
waist,  and  a  flat  plate  electrode,  3  in.  by  4  in.,  or  large  cup 
sponge  electrode,  is  held  against  the  epigastrium  by  the 
patient  himself — the  cathode  being  used  for  the  purpose. 
For  the  active  electrode  the  anode  is  used,  the  electrode 
itself  being  a  medium  size  of  cup  sponge  type.  With  a 
current  of  three  milhamperes  in  the  circuit,  this  electrode 
should   be   first   applied   to   the    epigastrium,    and   rubbed 


188  NATURAL     THERAPY 

backwards  and  forwards  for  about  one  minute.  With 
the  hair  moistened,  the  electrode  should  be  passed 
over  the  surface  of  the  head,  and  be  held  at  the  vertex 
for  about  two  minutes,  while  the  current  is  increased 
up  to  ten  milliamperes,  and  then  gradually  reduced  to  zero 
again. 

The  neck  is  then  treated  with  a  current  of  about  the 
same  strength  ;  the  active  electrode  is  next  passed  up  and 
down  the  spinal  furrow  for  about  ten  minutes,  and  then, 
the  current  having  been  reduced  to  zero,  removed,  and  the 
skin  carefully  dried.  It  is  of  great  importance  to  avoid 
any  sudden  changes  of  current  strength.  Pain  is  caused 
to  the  patient  if  the  electrode  be  applied  to  any  point  where 
the  skin  is  broken  or  cut. 

Central  galvanism  is  effective  where  we  desire  to  influence 
the  various  centres  in  brain  and  cord,  and  often  markedly 
improves  various  functional  nervous  conditions,  such  as 
hysteria,  neurasthenia,  insomnia,  dyspepsia,  and  also 
chorea  and  exophthalmic  goitre. 

General  Rules  as  to  Dosage,  etc. 

1.  The  strength  of  the  current  employed  in  individual 
cases  varies  considerably ;  it  will  very  seldom  exceed  twenty 
milliamperes,  and  generally  speaking  will  range  from  five  to 
twenty.  A  reliable  galvanometer  is  employed  to  determine 
the  amount  of  current  passing  at  any  moment. 

2.  Children  are  much  more  sensitive  to  currents  than 
adults. 

3.  The  electrodes  must  be  placed  in  position  before 
the  current  is  turned  on.  Much  care  is  needed  in  turning 
on  the  current,  and  in  increasing  and  decreasing  the 
strength,  to  avoid  sudden,  abrupt  changes,  which  are 
both  unpleasant  and  painful  to  the  patient. 

4.  As  a  rule,  ten  minutes  suffices  for  an  ordinary  seance. 

5.  In  chronic  cases,  treatment  three  times  a  week  is 
usual ;  in  acute  cases  it  may  be  desirable  to  give  several 
applications  in  one  day. 

6.  The  duration  of  a  course  must  naturally  vary 
considerably  with  the  nature  of  the  complaint.  In 
paralytic  cases  treatment  is  sometimes  continued  for 
a  year  or  more. 


GALVANISM    AND     FARADISM 


189 


Therapeutic  Indications. 

Stabile  anodal  applications  of  galvanic  current  are  sedative 
in  effect,  and  are  of  service  in  the  treatment  of  painful  and 
spasmodic  conditions — neuralgia  and  sciatica,  and  various 
morbid  states  dependent  on  over-excitability.  Stabile 
and  labile  applications  of  the  cathode  are  stimulating  in 
effect  on  nerves  and  voluntary  and  involuntary  muscles  ; 
they  are  largely  utilized  in  the  treatment  of  various  paretic 
and  paralytic  conditions. 

FARADISM,  OR  THE  INTERRUPTED  CURRENT. 

Michael  Faraday  found  that  in  a  close  circuit  a  current  is 
induced  as  often  as  a  magnet  is  approached  to  or  with- 
drawn from  this  conductor,  or  as  often  as  a  current  is  closed 
or  interrupted  in  the  vicinity  of  the  closed  circuit. 


^~'S-  93- — Spamer's  Induction  Coil,  with  Dry  Cell. 

This  discovery  was  the  first  step  in  the  direction  of 
producing  electricity  by  mechanical  power — towards  the 
dynamo,  telephone,  and  all  the  other  electrical  innovations 
of  the  past  half-centur\\ 


190 


NATURAL     THERAPY 


The  Induction  Coil. — This  coil  has  been  generally 
adopted  as  the  source  of  interrupted  currents .  in  medical 
work.  It  is  an  inexpensive,  portable,  and  generally  con- 
venient method  of  producing  motor  and  sensory  effects. 
Faradism  is  admirable  where  electrical  stimulation  is 
required,  and  its  only  drawback  is  that  there  is  no  easy 
or  entirely  reliable  means  of  estimating  the  strength  of 
the  current  we  employ.  There  is  a  great  variety  of  coils  on 
the  market.  That  of  Spamer  {Fig.  93)  is  very  convenient, 
and  with  fair  usage  will  last  a  long  time.  The  writer 
has  had  one,  made  by  Mr.  Schall,  for  nearly  fifteen  years, 


Fig.  94. — I.ewis  Jones's  Sledge  Coil. 

and  it  is  still  in  excellent  working  order.  The  current 
strength  is  more  easily  regulated  if  a  sledge  coil,  such  as 
Dr.  Lewis  Jones's,  be  employed  {Fig.  94). 

Construction  of  Medical  Coils. — The  shape  and  external 
appearance  of  the  coils  employed  for  medical  purposes  vary 
greatly,  but  (if  we  except  the  magneto-electric  machines, 
which  are  now  rarely  used)  they  are  all  constructed  on 
the  same  principle.  The  primary  coils  have  between  100 
and  300  turns  of  wire.  The  resistance  of  the  primary 
coil  should  vary  from  five  to  fifteen  ohms,  so  that  even 
two  cells  can  produce  a  strong  current  in  it.  The  dia- 
meter of  the  wire  ought,  therefore,  not  to  be  too  small. 
Insulated  copper  wire,  No.  22  B.W.G.,  is  generally  used 


GALVANISM    AND     FARADISM 


191 


for  the  primary  coils.  The  E.M.F.  of  the  primary 
current  varies  under  these  circumstances  between  five 
and  thirty  volts,  according  to  the  number  of  turns,  and 
whether  the  iron  core  is  drawn  out  or  pushed  home. 


Fig.  95. — Scheme  of  Galvano-faradic  Battery  with  Sledge-coil,  Double   Collector,  Current 
Reverser,  Galvanometer,  and  Cell  Connections  shown. 

Origin  of  Induced  Currents.— If  the  two  ends  of 
a  wire  are  connected  with  a  sensitive  galvanometer,  and  a 
magnet  brought  near  the  wire,  the  needle  of  the  galvano- 
meter declines  so  long  as  the  magnet  is  approaching,  and 
returns  to  zero  if  the  interval  between  wire  and  magnet  is 
allowed  to  remain  constant. 


s- 


Fig.  96. — Diagram   Illustrative  of  Induced  Currents. 

If  the  magnet  be  withdrawn,  the  needle  declines  again, 
but  in  the  opposite  direction.  If  in  the  neighbourhood 
of  the  closed  conductor  a  second  wire  is  drawn  parallel 
to  the  first,  and  this  second  wire  is  connected  with  a 
galvanic  cell,  the  needle  deflects  the  moment  the  circuit  is 
closed,  although  there  is  no  connection  whatever  between  the 


192 


NATURAL     THERAPY 


two  wires  ;  but  it  returns  to  zero  im  mediately  afterwards, 
and  remains  there,  although  the  galvanic  current  continues 
to  circulate  in  the  second  wire.  If  we  diminish  or  interrupt 
the  current,  the  needle  deflects  again,  but  in  the  opposite 
direction ;  thus  showing  that  the  approaching  and  with- 
drawing of  the  magnet— or  the  making  and  breaking 
of  a  current  in  a  conductor  close  by — induces  currents  in  a 
closed  circuit,  which  are,  however,  of  very  short  duration 
and  pass  in  opposite  directions. 

Alternating  Currents. — The  currents  induced  by  closing 
a  galvanic  current  pass  in  the  direction  opposite  to 
that  of   the  inducing  current,  those   induced   by  breaking 


Fig.   97. — Hovent's  Sledge  Coil,  with  a  special  device  for  obtaining  slow  to  rapid 
interruptions,   varying  from   30  to  1500  per  minute. 

the  inducing  current  pass  in  the  same  direction  as  the 
inducing  current.  If  we  make  and  break  the  inducing 
current  very  often  consecutively,  we  induce  each  time  a 
momentary  current  in  another  conductor ;  but  the 
directions  of  these  induced  currents  keep  changing,  and 
for  this  reason  we  call  them  alternating  currents,  in  contrast 
to  those  which  keep  their  polarity. 

Wagner's  hammer  is  most  frequently  used  for  rapidly 
making  and  breaking  the  current.  The  current  passes 
through  the  electro-magnet,  through  the  hammer,  the 
contact  screw,  and  back  to  the  battery  ;  or  else  it  can 
be  made   to  pass    from    the    contact    screw,  through  the 


GALVANISM    AND     FARADISM  193 

inducing  wire,  and  then  back  to  the  battery.  As  soon  as 
this  arrangement  is  connected  with  a  cell,  the  electro- 
magnet becomes  magnetic  and  attracts  the  hammer,  which 
consequently  leaves  the  platinum  point  of  the  contact 
screw.  This,  however,  interrupts  the  current,  the  electro- 
magnet ceases  to  be  magnetic,  and  a  spring  causes  the 
hammer  to  fly  back  ;  as  soon  as  it  touches  the  platinum 
point  again,  the  current  is  once  more  closed  and  the  hammer 
attracted,  and  this  play  lasts  as  long  as  the  apparatus 
is  connected  with  a  cell  giving  a  current. 

Self-induction.  Extra  Currents. — The  wire  through 
which  the  inducing  current  passes  is  called  the  primary 
wire,  and  the  wire  in  which  currents  are  induced  is 
called  the  secondary  ;  the  induced  current  is  called  the 
secondary  current.  For  various  reasons  the  primary  and 
secondary  wires  are  not  drawn  in  a  straight  line,  but  are 
wound  in  spirals  on  cylinders  of  wood,  paper,  etc.,  which 
are  made  of  such  sizes  that  the  primary  coil  can  be  pushed 
into  the  secondary  coil.  In  a  spiral,  each  turn  of  the  wire 
is  parallel  with  the  previous  and  following  turns  of  the 
same  spiral ;  and  a  current  which  passes  through  a  turn 
of  the  spiral  must  therefore  have  an  inducing  influence 
on  the  other  turns  close  by.  This  effect  of  the  different 
turns  of  the  same  spiral  on  each  other  is  called  self- 
induction,  and  the  current  thus  induced  is  called  the  extra 
current.  If  the  current  is  made,  the  extra  current,  too, 
has  an  opposite  direction  to  the  inducing  current,  and 
thereby  retards  and  weakens  it  and,  consequently,  the 
secondary  also  ;  but  if  the  inducing  current  is  interrupted, 
the  extra  current  flows  in  the  same  direction  as  the  inducing 
current,  and  thereby  increases  the  latter  considerably,  and 
the  secondary  current  as  well.  The  shocks  induced  by 
making  and  breaking  the  inducing  current  are,  therefore, 
of  very  unequal  strength  ;  those  made  by  breaking  the 
inducing  current  predominate  very  much,  and  the  signs 
+  and  - ,  which  are  the  terminals  of  the  better  induction 
coils,  are  intended  to  show^  the  direction  of  the  currents 
induced  b}^  breaking  the  inducing  current.  The  signs 
would  have  no  meaning  if  the  currents  resulting  from 
making  and  breaking  the  inducing  current  had  an  equal 
strength,  as  they  follow  one  another  in  opposite  directions. 

13 


194  NATURAL     THERAPY 

Primary  Currents. — If  we  connect  one  or  two  galvanic 
cells  with  a  Wagner's  hammer,  which  is  provided  with  a 
small  electro-magnet  only,  and  connect  the  cells  by 
two  further  wires  with  two  electrodes,  which  we  hold 
in  our  hands,  we  shall  not  feel  the  making  or  breaking 
of  the  current.  But  if  the  current  has  to  pass  a  primary 
coil  with  several  hundred  turns  of  wire  besides  the  Wagner's 
hammer,  each  breaking  of  the  current  gives  us  a  decided 
shock,  the  strength  of  which,  amongst  other  things,  depends 
upon  the  number  of  turns  of  the  coil,  and  varies  with 
the  extra  current.  This  is  the  primary  current,  which 
we  obtain  from  medical  induction  apparatus  ;  it  is  an 
intermittent  galvanic  current,  very  considerably  increased 
by  the  extra  current,  but  it  is  not  alternating.  The 
inducing  effect  of  a  current  is  considerably  increased 
by  letting  it  act  simultaneously  with  a  magnet,  and  this 
can  be  arranged  easily  if  the  primary  wire  is  wound  round 
an  iron  core,  or  better,  if  it  is  wound  round  a  cylinder  into 
which  an  iron  core  can  be  pushed.  It  is,  however,  prefer- 
able that  the  core  should  consist  of  a  bundle  of  soft 
iron  wires,  as  these  take  and  lose  magnetism  much  more 
quickly  than  solid  iron. 

The  Electro-motive  Force  of  the  induced  current  depends 
(i)  On  the  number  of  turns  of  wire  which  a  coil  has  :  the 
more  turns  the  higher  the  E.M.F. ;  (2)  On  the  strength  of 
the  inducing  currents  :  the  stronger  the  latter,  the  higher 
the  E.M.F.  of  the  induced  currents ;  (3)  On  the  presence  or 
absence  of  an  electro-magnet  :  its  presence  increases  the 
E.M.F.  of  the  induced  current  very  materially ;  (4)  On 
the  suddenness  of  the  break  of  the  inducing  current. 
Ultimately  the  E.M.F.  of  the  secondary  current  depends 
on  the  distance  between  the  secondary  and  primary  coils  : 
the  closer  they  are  together,  the  higher  is  the  E.M.F.,  and 
vice  versa. 

Strength  of  the  Induced  Current. — This    depends,    too, 

on  Ohm's  law.     If,  for  instance,  an   induced  current  has 

70  volts,  and  the  resistance  of  the  secondary  coil  is  610 

ohms,  and  the  resistance  of  the   patient  2,300  ohms,  the 

strength  of  the  current  would  be  : — 

70  volts  ,  ....         , 

-7 z —  0-024  amperes  —  24  milliamperes. 

DIG  -|-  2,300  ohms 


GALVANISM  AND  FARADISM    195 

The  strength  of  an  induced  current  cannot  be  measured 
with  an  ordinary  galvanometer,  because  the  secondary 
current  is  alternating,  and  would  therefore  make  the  needle 
deflect  one  moment  to  the  right,  and  the  next  moment  to 
the  left.  Some  galvanometers  which  are  constructed 
without  permanent  magnets  might  be  used ;  but  the  chief 
obstacle  is  that  the  currents  are  intermittent,  and  since 
each  impulse  lasts  but  a  very  short  time  the  galvanometer 
remains  for  a  while  without  any  current,  until  a  second 
impulse  occurs.  If  there  are  thirty  interruptions  per 
second,  such  a  galvanometer  would  indicate  more  current 
than  if  there  are  only  five  interruptions  per  second, 
although  in  both  cases  the  actual  strength  of  current 
would  not  vary.  The  only  possibility  of  measuring  the 
currents  of  faradic  coils  in  absolute  units  consists  in 
measuring  their  E.M.F.,  and  later  on  we  shall  describe  an 
apparatus  for  this  purpose. 

The  chemical  action  of  faradic  currents  is  small, 
principally  on  account  of  their  very  short  duration,  and, 
moreover,  because  they  are  alternating,  so  that  each  follow- 
ing impulse  in  the  secondary  current  partly  neutralizes 
the  effect  of  the  preceding  impulse.  The  mechanical 
effect  of  these  suddenly  appearing  and  disappearing  currents 
on  the  human  body,  however,  is  very  intense.  If  we  place 
electrodes  on  the  body,  the  muscles  contract  each  time  the 
current  is  made,  and  much  more  so  when  it  is  broken,  so 
that  they  can  be  excited  with  these  currents  to  a  great 
extent. 

Differences  in  the  Effects  produced  by  Primary  and 
Secondary  Currents. — The  effect  produced  by  the  secondary 
current  depends  a  great  deal  on  the  diameter  of  the  wire 
which  is  used.  Very  fine  wires  (o'l  millimetre,  or  finer) 
produce  a  pricking  local  pain,  but  not  ver}^  strong  muscular 
contractions  ;  if  we  increase  the  diameter  of  the  wire,  the 
contractions  become  more  powerful ;  if  the  secondary  coils 
are  wound  with  thick  wire  (No.  i8  to  22  B.W.G.),  they 
produce  exactly  the  same  effects  as  primary  current,  i.e., 
less  local  pain,  but  powerful  contractions  of  the  muscles 
near  the  electrodes,  or  even  in  the  whole  body.  The 
primary  or  the  secondary  current  produced  in  a  coil  with 
thick  wire  is  frequently  applied  when  the  deeper-lying  organs, 


196  NATURAL    THERAPY 

such  as,  for  instance,  the  bowels,  are  to  be  treated ; 
whereas  the  secondary  current  produced  by  a  coil  with 
fine  wire  is  chiefly  used  for  treatment  of  muscles  and  nerves 
which  lie  near  the  skin.  This  is  the  practical  difference 
between  primary  and  secondary  currents.  It  is  no  doubt 
entirely  due  to  the  great  difference  in  the  resistance  of  the 
coils  and  in  the  E.M.F.,  but  it  is  impossible  to  draw  a  sharp 
line  between  them,  and  to  define  accurately  in  what  cases 
the  one  or  the  other  should  be  applied.  For  the  electric 
bath  the  primary  current,  or  a  secondary  coil  with  thick 
wire,  only  can  be  used. 

Regulation  of  the  Primary  Currents. — The  E.M.F.  of 
the  primary  current  can  be  regulated  in  different  ways  : 
for  instance,  by  inserting  a  larger  or  smaller  number  of 
turns  of  wire  by  means  of  a  crank,  etc.  The  simplest  and 
almost  only  practical  method,  however,  is  to  regulate 
the  E.M.F.  by  pushing  the  iron  core  in  and  out.  The 
primary  current  is  weakest  if  the  iron  core  is  drawn  out, 
and  becomes  stronger  as  it  is  pushed  in.  Instead  of 
drawing  the  iron  core  out,  a  damper  in  the  shape  of  a 
brass  or  copper  tube  can  be  slipped  over  it  with  the  same 
effect.  If  the  iron  core  is  entirely  covered  with  the  tube, 
its  inducing  power  ceases,  but  the  E.M.F.  increases  the 
more  the  brass  tube  is  withdrawn.  The  position  of  the 
secondary  coil  has  no  influence  on  the  strength  of  the 
primary  current. 

Regulation  of  the  Secondary  Current. — The  secondary 
coil  is  generally  constructed  with  a  large  number  of  turns 
of  wire,  about  2,000  to  6,000,  for  in  most  cases  it  is 
desired  ta  obtain  a  high  E.M.F.  The  wire  used  is 
generally  thin  copper,  about  No.  36  B.W.G.  The 
resistance  of  the  secondary  coil  varies  under  these  circum- 
stances between  100  and  900  ohms,  and  the  E.M.F.  between 
10  and  200  volts.  The  strength  of  the  secondary  current 
can  be  regulated  in  different  ways.  If  the  apparatus 
has  a  small  primary  coil,  it  is  sufficient  for  all  purposes  of 
treatment  to  regulate  the  strength  of  the  secondary  current 
by  merely  pushing  the  iron  core  in  and  out,  for  a  current 
which  is  hardly  to  be  felt  when  the  iron  core  is  drawn  out, 
can  be  increased  quite  gradually  to  painful  strength  by 
pushing  it  home.     The  more  complete  coils,  however,  are 


GALVANISM    AND     FARADISM 


197 


so  arranged  that  the  distance  between  the  primary  and 
secondary  coil  can  be  easily  changed  {see  Fig.  98).  In  this 
case  the  secondary  coil  slides  on  a  sledge,  and  can  be  pushed 
over  the  primary,  or  be  drawn  away  from  it,  an  arrange- 
ment which  allows  an  exceedingly  fine  regulation  of  the 
current.  These  sledge  coils,  which  were  first  suggested  by 
Du  Bois  Raymond,  are  decidedly  preferable  to  any  others 
for  diagnostic  and  physiological  purposes.  The  strength 
of  current  in  this  apparatus  can  be  further  regulated  by 
pushing  the  iron  core  in  and  out  {Fig.  100).  The  secondary 
current  might  also  be  regulated  by  means  of  a  crank  which 
inserts  more  or  less  turns  of  wire,  but  this  does  not  allow 
of  as  fine  graduation  as  the  moving  of  the  iron  core  or 
the    coils ;    or    it    might    be    regulated   by   rheostats,    but 


^-F^  Sou  '?rim.^,+ 

Fig.  98. — Diagram  illustrating  the  Regulation  of  the  Secondary  Current. 

this  is  not  very  practicable,  and  is  seldom  employed,  as 
high  resistances  would  be  required. 

Rapidity  of  Interruptions. — The  Wagner  hammer  of 
an  induction  apparatus  {Fig.  99)  can  be  regulated  within 
certain  limits,  so  that  the  interruptions  follow  one  another 
with  greater  or  less  rapidity.  The  sooner  the  hammer 
meets  the  platinum  point  again  after  having  been  drawn 
away  from  the  electro-magnet  by  the  force  of  a  spring,  the 
sooner  the  current  is  closed  and  the  hammer  attracted 
again.  The  further  we  close  this  contact  screw,  the 
quicker  will  be  the  vibrations ;  but  if  we  make  it 
too  tight  the  hammer  has  no  room  for  moving,  and 
ceases  to  work,  and  vice  versa ;  but  we  must  not 
unscrew  it  too  far,  for  the  hammer  must  make  good 
contact  with  the  platinum  point  in  flying  back,  or  it  will 


198 


NATURAL     THERAPY 


Fig.  99. — The  Wagner  Hammer. 


also  cease  to  vibrate.  The  power  of  the  spring  as  well 
as  the  strength  of  the  inducing  current,  have,  however, 
something  to  do  with  the  rapidity  of  the  interruptions.  In 
order  to  make  these  still  slower,  the 
hammer  can  be  lengthened  with  a 
bar,  on  which  an  aluminium  ball 
can  be  raised  or  lowered.  The 
longer  this  pendulum  is,  the  slower 
are  the  interruptions  ;  they  can  be 
reduced  to  twenty  or  even  less  per 
minute.  Some  apparatus  are  fitted 
with  clockwork,  which  can  be  made 
to  run  at  any  speed,  and  the  interrup- 
tions produced  per  minute  are 
accurately  registered  by  this  means. 
Slow  interruptions  produce  more 
powerful  and  painful  contractions 
than  quick  ones.  If  the  number  of 
interruptions  is  very  great,  anaesthesia 
can  be  produced,  and  apparatus  of  high  rate  of  speed 
have  been  made  for  obtaining  this  result  {Fig.  97). 

Types  of  Cell  employed. — The  bichromate  cell  previously 
mentioned  is  one  of  the  best.  It  has  a  high  E.M.F.,  small 
internal  resistance,  and  is  easily  kept  in  order. 

Dry  cells  of  the  Leclanche  type  are  so  well  suited 
for  portable  induction  coils  that  they  have  practically 
superseded  all  other  cells  for  this  purpose.  There  is  no 
corrosive  fluid  to  spill,  and  they  are  constant  in  action. 
Schall  finds  that  the  Obach  R  cell,  size  if  in.  by  if  in. 
by  4-I  in.  for  instance,  will  work  a  Spamer  coil  for  thirty 
to  sixty  hours  (with  the  iron  core  out  or  in  respectively), 
and  the  cell  can  be  replaced  at  very  small  cost,  less 
than  that  of  the  acid  and  zinc  used  in  the  same  time, 
not  to  speak  of  the  risk  of  spilling  and  injuring  battery 
or  clothes. 

Failure  to  Work. — If  an  induction  coil  fails,  it  should 
first  be  seen  whether  the  element  is  exhausted.  Acid  cells 
require  refilling  about  once  in  a  fortnight  if  the  apparatus 
is  in  daily  use.  If  it  is  certain  that  the  cell  is  all  right 
and  gives  the  necessary  current,  one  should  see  whether 
the  interrupter  is  in  order.     The  interrupter  is  the  most 


GALVANISM    AND     FARADISM  199 

delicate  part  of  the  induction  coil,  and  therefore  care  is 
necessary  not  to  interfere  with  the  contact  screw  if  it  is  not 
strictly  necessary  ;  for  very  often  apparatus  which  were 
in  quite  good  order  have  been  spoiled  by  playing  with  this 
screw.  The  interrupter  does  not  always  start  of  its  own 
accord,  and  has  to  be  put  in  vibration  by  being  slightly 
touched  with  the  finger.  The  hammer  should  be  arranged 
so  that  its  distance  from  the  electro-magnet  is  about  the 
xVth  part  of  an  inch,  and  the  platinum  point  of  the  contact 
screw  should  just  touch  it.  Those  apparatus  in  which 
the  hammer  is  fastened  to  a  rigid  bar,  as  in  all  sledge  coils, 
are  less  liable  to  get  out  of  order  and  to  require  readjustment 
than  coils  the  hammer  of  which  is  attached  to  a  watch- 
spring.  The  interruptions  of  these  latter  apparatus  are 
also  frequently  less  regular.  If  an  interrupter  has  not  the 
proper  distance  from  the  electro-magnet,  it  has  to  be 
carefully  bent  till  it  keeps  the  correct  distance.  The  spark 
on  the  interrupter  attracts  dust,  and  the  little  platinum 
sheet  should  be  cleaned  occasionally  with  fine  emer}'  paper. 
Oil  should  on  no  account  be  allowed  on  the  interrupter. 

If  the  apparatus  still  fails,  although  cell  and  interrupter 
are  right,  see  whether  the  connecting  cords  are  in  order. 
To  try  an  apparatus  by  touching  the  terminals  or  the 
connecting  cords  with  two  fingers  is  useless.  It  can 
only  be  tested  with  well  soaked  and  properly  connected 
electrodes.  The  coil  and  the  connections  are  very  well 
protected,  and  can  be  damaged  only  by  spilling  a  good  deal 
of  acid  ;  the  connections  become  oxidized  in  such  a  case, 
or  the  wires  may  even  be  eaten  through.  An  apparatus 
damaged  in  this  way  has  to  be  sent  back  to  the  manu- 
facturer for  repair. 

The  Regulation  and  Measurement  of  the  Current 
Strength. — Some  means  of  regulating,  to  a  greater  or  less 
degree,  the  strength  of  the  current,  is  necessary. 

The  following  are  the  methods  commonly  employed  : — 

I.  The  strength  of  the  magnetic  field  is  varied  by  the  use 
of  a  sliding  core,  as  shown  in  Fig.  loo.  A  small  auxiliary 
electro-magnet  is  employed  to  work  the  interrupter.  The 
current  is  a  somewhat  irregular  one  of  low  frequency.  The 
interruptions  are  rather  unpleasant  to  the  patient,  and  such 
instruments  are  ill-adapted  for  delicate  electrical  testing. 


200 


NATURAL     THERAPY 


2.  A  movable  secondary  coil  is  used,  which  can  be  brought 
into  weaker  or  stronger  parts  of  the  magnetic  field  of  the 
instrument.  This  method  gives  a  wide  range  of  current 
strength,  but  is  only  suitable  for  regulating  the  secondary 
current. 

3.  The  iron  core  of  the  primary  coil  may  be  covered  by 
means  of  a  metal  tube  which  slides  over  it  and  shields  the 
coils  from  its  magnetic  action. 


Fig.  100. — Du  Bois  Raymond'?  Coil,  with  Adjustable  Interrupter  and  Sliding  Core  for 
regulating  current  strength. 

4.  The  current  strength  may  be  varied  by  means  of  inter- 
posed resistance  in  the  exciting  or  secondary  circuit. 

5.  A  switch  mav  be  used  which  brings  into  action  a 
greater  or  less  number  of  the  windings  of  the  secondary  coil. 

Measurement  of  Faradic  Currents.  —  Galvanometers 
are  not  satisfactory  for  this  purpose  for  two  reasons  : 
many  of  the  instruments  which  are  capable  of  measuring 
the  alternating  currents  (for  instance,  the  "  hot  wire  " 
galvanometers)  cannot  yet  be  made  so  sensitive  that 
they  would  indicate  a  few  milliamperes  ;  they  are  only 
useful  for  currents  from  lifty  milliamperes  upwards.  The 
second,  and  more  important  reason,  is  that  galvanometers 
cannot  be  used  unless  all  the  interrupters  of  the  coils,  the 
current  of  which  is  to  be  measured,  vibrate  at  a  uniform 
and  fairly  rapid  rate,  because,  as  mentioned  previously,  a 


GALVANISM  AND  FARADISM    201 

galvanometer  will  register  less  if  there  are  only  five 
interruptions  per  second  than  if  there  are  about  twenty 
in  the  same  time,  in  spite  of  the  fact  that  the  current 
may  be  of  exactly  the  same  strength  in  both  cases. 

Von  Ziemssen  and  Edelmann  have  shown  that  currents 
of  very  short  duration  and  a  certain  E.M.F.  give  the  same 
physiological  effects  whether  they  are  produced  by  an 
induction  coil,  a  galvanic  battery,  or  a  condenser  discharge. 
A  coil  was,  therefore,  constructed  in  which  the  scale  was 
graduated  in  volts  ;  the  readings  of  the  scale  are  correct 
as  long  as  there  is  a  primary  current  of  exactly  03  ampere. 
Further  condensers  were  constructed  of  one  microfarad 
capacity,  which  could  be  charged  from  a  battery  and 
discharged  through  the  patient  in  rapid  succession  by  a 
key  working  like  the  interrupter  of  a  coil.  If  the  number 
of  volts  used  for  charging  the  condenser  is  known,  the 
current  can  be  measured,  and  the  results  compared,  just 
as  the  number  of  milliamperes  with  a  continuous  current. 

The  use  of  a  continuous  current  with  an  interrupter 
worked  by  an  electric  motor  has  been  suggested  for  test- 
ing the  reaction  of  muscles,  and  for  treatment  with  the 
interrupted  current.  The  interrupter  or  reverser  is  fixed 
■on  the  axis  of  the  motor  ;  it  is  in  the  circuit  of  a  galvanic 
battery  (or  the  current  from  the  main),  and  a  milliampere- 
meter  is  also  in  the  circuit.  By  means  of  the  latter  the 
current  flowing  through  the  patient  can  be  measured  while 
the  interrupter  is  at  rest  ;  when  it  is  started,  the  galvano- 
meter will  indicate  less,  and  the  difference  between  the 
two  readings  can  be  used  to  find  out  the  duration  of  the 
■current.  If  the  galvanometer  indicates,  for  instance, 
one-fifth  of  its  former  reading,  it  shows  that  the  current 
is  closed  for  one-fifth,  and  "  off  "  for  four-fifths  of  the  time 
of  a  period  or  revolution.  The  proportion  between  the  time 
it  is  "on"  to  the  time  "off"  can  easily  be  varied  and 
adjusted  by  altering  the  position  of  one  of  the  two  brushes. 

It  has  been  proved  that  more  powerful  contractions  of 
muscles,  with  less  pain,  are  obtained  with  short  contacts 
and  long  intervals  with  no  current,  i.e.,  if  the  brushes 
are  so  adjusted  that  the  time  during  which  the  current 
is  closed  is  only  about  one-tenth  of  that  during  which  the 
current  is  "  off."     The  number  of  periods  or  interruptions 


202  NATURAL     THERAPY 

per  minute  can  be  adjusted  by  means  of  the  rheostat 
controlhng  the  speed  of  the  motor,  and  can  be  read  off 
a  speed  counter.  The  E.M.F.  used  can  be  regulated  by 
increasing  or  diminishing  the  number  of  cells  in  the  circuit. 

THE    TECHNIQUE    OF    FARADIZATION. 

The  faradic  current  may  be  applied  locally  or  generally,, 
and  by  the  stabile  or  labile  methods  {Plate  XXVII). 

The  electrodes  are  similar  in  character  to  those  used  for 
galvanism,  but  there  are  some  special  types,  such  as  the- 
wire  brush  electrode.  The  sponges  or  leather  covering 
should  be  moistened  with  salt  and  water,  or  if  the  sensory 
nerves  are  to  be  treated  the  skin  should  be  dusted  with 
cimolite  or  starch  powder. 

The  large  indifferent  electrode  should  be  placed  at  some- 
remote  part,  such  as  the  lumbar  muscles,  or  the  patient 
should  hold  it  in  his  hand. 

General  Faradization  brings  every  portion  of  the  body 
under  the  influence  of  the  current  so  far  as  is  possible  by 
outward  applications. 

The  patient  should  be  seated  on  a  stool  facing  the 
instrument,  and  for  the  first  part  of  the  process  should 
be  stripped  to  the  waist,  and  have  his  shoes  and  socks 
removed  ;  his  feet  should  be  placed  against  a  copper  sheet 
warmed  by  means  of  a  hot-water  bottle ;  the  surface- 
should  be  moistened  with  warm  water,  and  it  should  be 
connected  with  the  negative  pole  of  the  battery.  If  the- 
patient  is  paralyzed,  he  may  lie  on  a  couch  with  the  copper 
plate  beneath  his  buttocks.  The  other  electrode  consists- 
of  a  brass  ball  (6  in.  diameter)  covered  with  damp  wash- 
leather  or  felt,  or  the  moistened  hand  of  the  operator, 
connected  with  the  anode. 

When  the  hand  is  used  as  the  active  electrode,  the  covered, 
brass  ball  electrode  should  be  held  in  the  other  hand,  or 
allowed  to  rest  on  a  table  and  be  lightly  touched,  at  first,, 
with  the  other  hand.  The  strength  of  the  current  can  then 
be  gauged  by  the  operator's  own  sensation,  and  the 
flexibility  of  the  hand  allows  of  easy  adaptation  to  varying 
surfaces.  A  very  mild  current  should  be  used  at  first,, 
and  gradually  increased. 


PLATE     XXVII. 


Electric   Massage. 

The  current  is  here  led  from  the  main — after  suitable  resistance  has  been  interposed  — 
by  a  cord  (not  seen  in  illustration)  to  the  spongio-piline  pad  under  the  operator's  left  hand. 
The  patient  lies  on  the  negative  (plate)  electrode.  It  is  often  preferable  for  the  operator 
to  draw  the  current  from  a  moist  sponge  electrode,  which  he  holds  with  varying  firmness 
in  one  hand,  while  he  uses  the  other  hand  as  an  electrode,  and  with  it  massages  the 
patient. 

In  this  manner  current  strengths  can  be  gn'aduated  with  much  precision,  and  faradism 
can  be  rendered  extremely  agreeable  and  painless.  The  flexibility  of  the  hand,  and  its 
adaptability  to  any  surface  of  the  body,  renders  it  a  most  excellent  electrode. 


GALVANISM  AND  FARADISM    20B 

The  moistened  hand  should  be  first  appHed  to  the  patient's 
forearm,  and  the  circuit  then  completed  by  placing  the 
other  hand  on  two  covered  brass  electrodes — the  positive 
pole.  The  hand  is  then  passed  over  the  moistened  hair 
of  the  patient's  head,  over  his  neck,  throat,  up  and  down 
the  spine,  arms  and  hands,  then  the  surface  of  the  abdomen, 
and  finally  the  legs.  Duration  of  seance,  from  five  to 
twenty-five  minutes  ;  fifteen  minutes  is  a  very  average 
time,  apportioned  in  the  following  manner  : — 

Head         -  -  -  -     i  minute. 

Neck  and  throat  -  -  4  minutes. 

Upper  and  lower  extremities         -     4        ,, 
Abdomen         -  -  -  3         ?i 

Back  -  -  -  -     3         >> 

The  treatment  is  applied  about  three  times  a  week,  the 
length  of  the  course  entirely  depending  on  the  chronicity 
and  nature  of  the  case  dealt  with.  After  the  treatment 
the  patient  feels  considerably  invigorated,  the  sensation 
of  exhilaration  continuing  for  several  hours  ;  sometimes 
drowsiness  results.  The  pulse  is  steadied,  depression 
relieved,  appetite  and  digestion  improved,  and  muscular 
energy  and  bod^^-weight  increased.  Sometimes  there  is 
slight  soreness  of  the  muscles. 

Therapeutic    Indications. 

General  faradization  is  useful  in  the  treatment  of  various 
functional  nerve  diseases,  such  as  hysteria,  neurasthenia, 
and  nervous  dyspepsia.  It  improves  the  tissues  of  the 
muscles  in  various  paralytic  conditions,  and  takes  the  place 
of  exercise  and  massage. 

Galvano-faradization. — The  combined  use  of  galvanic 
and  faradic  current,  as  suggested  by  de  Watteville,  is 
effected  b}'  uniting  the  secondary  induction  coil  and 
galvanic  battery  in  one  circuit,  by  connecting  with  a  wire 
the  negative  pole  of  the  one  with  the  positive  pole  of  the 
other ;  the  electrodes  are  attached  to  the  two  extreme 
poles,  and  both  currents  are  sent  through  the  body.  The 
special  key  of  de  Watteville  is  useful  in  this  combination. 
The  effect  of  this  combined  current  is  at  once  stimulating 
and  soothing. 


204 


CHAPTER    XIII. 

SINUSOIDAL    CURRENTS. 

HYDRO  -  ELECTRIC     BATHS. 

STATIC    ELECTRICITY. 

SINUSOIDAL    CURRENTS. 

'HP  HE  word  sinusoidal  has  been  used  to  describe  a  wave-like 
-*-  alternating  current,  such  as  is  produced  by  an  alternating 
current  dynamo,  and  to  distinguish  it  from  the  irregular, 
jerky  alternating  current  produced  by  a  faradic  coil.  When 
a  copper  coil  rotates  with  uniform  velocity  between  the 
poles  of  an  electro-magnet,  the  current  collected  is  sinusoidal, 
i.e.,  its  intensity  is  proportional  to  the  sine  of  the  angle 
between  the  plane  of  the  coil  and  the  line  of  commutation. 


Fig.  loi. — Curve  of  a  Sinusoidal 
Current. 


I02. — Curve  of  the  Secondary  Current  of  a 
Faradic  Coil. 


Figs.  loi  and  102  respectively  show  the  curves  of  a  sinu- 
soidal current  and  the  more  jerky  movement  of  the 
secondary  current  of  a  faradic  coil.  The  latter  type 
produces  somewhat  painful  contractions  of  the  muscles, 
whereas  the  smooth  sinusoidal  currents  may  cause  equally 
powerful  contractions,  but  they  are  not  so  much  felt  b}' 
the  patient.  They  are  also  free  from  the  electrolytic  effects 
produced  by  a  continuous  current. 


SINUSOIDAL     CURRENTS 


205 


We  distinguish  between  single-phase  and  poly-phase 
sinusoidal  currents.  For  medical  purposes  three-phase 
currents  are  frequently  employed,  and  to  obtain  them 
a  peculiar  connection  of  the  winding  of  the  armature  is 
necessary.  It  is  arranged  in  three  groups,  each  of  which 
occupies  one-third  of  the  circumference  of  the  armature. 
One  end  of  each  group  is  connected  with  one  of  the 
three  collecting  rings   shown  in   the  illustration  {Fig.  103), 


Fig.  103. — Diagram  showing  arrangement  for  producing  Three-phase  Currents. 

and  the  other  ends  are  connected  together.  While  the 
first  group  is  near  the  north  pole  of  the  dynamo,  the 
second  is  120  degrees  farther  ahead  [Fig.  104),  past  the 
neutral  point,  and  on  the  way  to  the  south  pole ;  the  third 


Fig.  104. 


group  is  240  degrees  ahead,  past  the  south  pole  already, 
and  approaching  the  second  neutral  point.  Three  separate 
waves  are  thus  generated,  and  are  interwoven  as  shown 
in  Fig.  105,  in  which  the  three  zigzag  hues  on  the  left 
represent  the  three  groups  of  wire  on  the  armature,  and  the 
dotted  curves  on  the  right  the  three  waves  of  current  in 
the  external  circuit  passing  through  the  primaries  of  the 
three  sledge  transformers. 


206 


NATURAL     THERAPY 


The  most  convenient  way  to  produce  sinusoidal  currents 
is  to  have  a  continuous  current  motor  provided  with  extra 
collector  rings,  from  which  the  sinusoidal  current  can  be 
taken  off  {Fig.  io6).  If  it  has  two  rings,  single-phase  cur- 
rents only  can  be  obtained  ;  if  it  has  three,  single-phase  or 
three-phase  currents  can  be  employed  ;  in  the  first  case 
two,  in  the  second  case  three,  electrodes  have  to  be  placed 
simultaneously  on  the  patient.  The  three-phase  sinusoidal 
current  is  the  most  pleasant  to  bear ;  and  strong  doses 
can  be  administered  in  this  form. 


Fig.  io6. — Motor  Transformer,  arranged  for  Single  or  Three-phase  Sinusoidal  Currents 
and  including  three  Sledge  Transformers. 

The  Herschell-Dean  Triphase  Generator. — This  appa- 
ratus consists  of  a  field  armature  with  commutator,  and 
having  equidistant  tappings  connected  to  slip  rings,  on 
which  brushes  are  held  in  contact  by  springs.  The  triphase 
currents  are  carried  by  flexible  connections  to  the  primaries 
of  three  induction  coils  arranged  in  parallel.  Instead  of  the 
secondaries  the  primaries  move  simultaneously  in  an  equal 
degree ;  this  is  the  same  electrically,  but  mechanically  is 
an  advantage.  The  secondaries  of  the  coils  are  also  in 
parallel,  but  are  not  mobile.  The  current  is  led  from  the 
coils  to  the  electrodes  by  flexible  cords,  which  are  attached 


SINUSOIDAL     CURRENTS 


207 


to  a  trident  plug,  which  simphfies  the  manipulation  of 
the  cords.  The  electrodes  being  in  intimate  contact  with 
the  skin,  the  circuit  is  formed  within  the  organism.  The 
E.M.F.  in  the  primary  is  controlled  by  a  rheostat,  and  the 
periodicity  by  a  break,  which  acts  by  virtue  of  the  load 
borne  by  the  generator,  and  reduces  the  number  of  revolu- 
tions.    If  the  break  be  gradually  applied  with  the  machine 


Fig.  107. — Herschell-Dean  Sinusoidal  Apparatus  for  Direct  Current  Mains,  witli  complete 
control  of  tension  and  period. 

running  at  full  speed,  a  progressive  reduction  in  revolutions 
and  alternations  is  caused  without  change  in  E.M.F.  of  the 
currents.  The  machine  should  never  be  suddenly  stopped 
with  the  electrodes  in  contact  with  the  patient,  or  he  will 
receive  a  shock.  To  stop  the  administration,  the  primaries 
must  be  moved  back  to  starting-point,  the  rheostat  be  put 
at  "  weak,"  and  the  current  switched  off.  The  electrodes 
may  then  be  safely  removed  {Fig.  107). 


208  NATURAL     THERAPY 

Two  distinct  types  of  current  are  obtainable  :  (i)  A 
rapidly  alternating  current,  with  powerful  action  on 
metabolism  and  markedly  tonic  effect ;  and  (2)  A  slowly 
alternating  current,  capable  of  especially  influencing  non- 
striped  muscle  tissue,  and  causing  painless  contractions. 

The  tripha.se  current  may  be  applied  :  (i)  By  electrodes 
— large  flat  felt,  or  sponge,  electrodes  being  best  suited 
for  skin  surfaces.  Gastric  and  rectal  electrodes  are  also 
employed ;  (2)  By  means  of  local  baths,  single  or 
multiple  (as  in  the  Schnee  bath)  ;  (3)  By  a  general  full 
bath  ;  (4)  External  electrodes  may  be  combined  with  baths. 

Herschell  finds  an  application  of  the  triphase  currents 
(i)  Increases  the  tension  and  amplitude  of  the  pulse ; 
(2)  Increases  excretion  of  urea  ;  (3)  Increases  the  peristalsis 
of  the  intestines  and  contractions  of  stomach,  and  generally 
exerts  a  powerful  stimulant  action  on  non-striped  muscle. 
He  finds  these  currents  of  great  value  in  the  treatment  of 
neurasthenia  and  gastric  myasthenia,  and  in  cases  of 
constipation  has  achieved  most  brilliant  results. 

Reginald  j\Iorton  has  also  lately  drawn  attention  to  the 
great  value  of  triphase  sinusoidal  currents  in  atonic  con- 
ditions of  the  stomach  and  intestines.  An  intragastric 
may  be  combined  with  a  rectal  electrode,  and  an  external 
plate  or  pad  applied  to  the  epigastrium.  The  patient 
may  in  this  way  be  at  once  treated  for  gastrectasis,  and 
the  constipation  which  so  frequently  accompanies  it. 

The  sinusoidal  current  is  an  extremely  pleasant  and 
useful  application,  either  in  small  local  baths  or 
the  full  electric  bath.  It  resembles  the  faradic  current, 
but  the  interruptions  are  smoother  and  much  less  painful 
to  the  patient.  By  means  of  these  baths,  various  spastic 
and  other  paralyses  can  be  conveniently  treated.  The 
current  appears  to  lessen  the  late  rigidity  sometimes  seen 
after  hemiplegia. 

THE     HYDRO-ELECTRIC     BATH. 

The  different  forms  of  current  employed  are  : — 

I.   Continuous. 

(a)  Uniform  (galvanic — from  main). 
{b)  Pulsatory  (from  a  dynamo). 


PLATE     XXVIII. 


The    Schnee    4-Cell    Bath. 


THE     HYDRO-ELECTRIC     BATH 


209 


2.  Alternating. 

(a)  Faradic  (c)  Galvano-faradic 

lb)  Sinusoidal  {d)  Galvano-sinusoidal 

The  bath  may  be  sectional  or  local,  or  a  whole  bath, 
involving  removal  of  all  clothing  and  complete  immersion 
of  the  patient. 

The  4-Cell  Bath  of  Dr.  Schnee. — This  is  a  sectional  bath, 
merely  the  hands  and  forearms  and  feet  of  the  patient 
being  immersed  in  separate  tubs  or  porcelain  cells.  Local 
baths  may  be  similarly  given  to  an  arm  and  leg  by  means 
of  a  porcelain  tub  through  which  the  current — galvanic, 
faradic,  or  sinusoidal — is  conducted. 

The  four-cell  bath  can  be  used  with  the  galvanic,  faradic, 
or  sinusoidal  currents  produced  by  batteries  or  by  dynamos  ; 


Fig.  loS. — Special  Commutator  for  a  4-Cell  Schnee  Bath. 

in  the  latter  case  there  is  no  danger  of  shock  as  in  a  full 
bath,  because  the  porcelain  tubs  are  not  connected  with  the 
water-pipes,  and  are  well  insulated  from  earth  {see  Plate 
XXVIII).  Drugs  may  be  added  to  the  water,  and  can 
be  introduced  through  the  skin  by  the  continuous  current. 
The  quantity  of  water  required  is  not  great,  so  that 
the  apparatus  does  not  depend  on  the  proximity  of  a 
water-supply. 

This  bath  is  specially  adapted  for  applying  all  kinds  of 
electric  current,  either  from  the  mains  or  accumulators. 
Several  advantages  are  claimed  in  favour  of  this  as 
compared  with  the  older  form  of  ordinary  full  bath, 
among  which  may  be  mentioned  the  following  : — 

I.  The  whole  electric  current  used  is  made  to  pass  through 
the  patient's  body — which  constitutes  the  only  connection 
between  the  electrodes — without  the  slightest  waste. 


210 


NATURAL    THERAPY 


2.  The  intensity  of  the  current  apphed  to  the  patient 
is  capable  of  being  measured  and  regulated  with  absolute 
accuracy,  for  the  reason  just  stated,  unlike  a  full  bath. 

3.  The  current  can  not  only  be  measured  and  regulated 
with  absolute  accuracy,  but  may  also  be  directed  more  than 
fifty  different  ways  through  the  body  by  a  simple 
device  on  the  switchboard. 

4  It  is  not  necessary  for  the  patient  to  undress,  it  being 
sufficient  to  have  the  forearms  and  feet  bare. 


Fig  109. — Diagrams  showing  tlie  Path  of  the  Current  by  the  4-CeIl  Bath. 

5.  The  patient  sits  erect.  The  chair  is  movable  in  all 
directions,  and  may,  therefore,  be  so  adjusted  that  the 
position  of  the  patient  is  perfectly  natural,  and  the  danger  of 
fright,  oppression  of  the  heart  or  chest,  and  the  like,  which 
frequently  attend  full  baths,  in  nervous  and  cardiac  cases, 
is  removed. 

6.  The  arms  rest  in  the  most  comfortable  position  in  the 
cell,  the  cell  supports  being  exactly  fitted  to  the  bather 
by  a  double-joint  movement  and  a  height  adjustment. 

7.  The  bath  may  at  once  be  stopped  by  the  patient 
himself  if  desired,  by  simply  lifting  his  arms  out  of  the  cells. 


THE     HYDRO-ELECTRIC     BATH         211 

The  strength  of  current  may  reach  to  about  twenty 
milHamperes.  The  current  voltage  required  is  about  twenty- 
live  volts.  With  the  faradic  current  the  patient  can  usually 
only  bear  five  or  six  milliamperes. 

The  Whole  Hydro-Electric  Bath. — The  whole  bath  is 
a  most  efficacious  method  of  applying  electrotherapy 
when  tonic  and  stimulating  effects  are  desired.  The 
bath  should  be  made  of  porcelain  or  wood,  and  stand  on 
vulcanite  blocks.  The  current  used  may  be  continuous  or 
alternating,  faradic-galvanic  or  galvano-faradic.  The  bi- 
polar bath  is  the  form  most  commonly  employed.  The 
electrodes  are  large  copper  plates  and  are  placed  in  the 
bath,  one  at  the  head  (the  anode)  and  the  other  (cathode) 
at  the  foot,  so  that  the  current  flows  from  the  patient's 
head  to  his  feet — through  his  body — the  line  of  least 
resistance. 

A  bar  and  electrode  are  sometimes  provided  in  addition, 
being  placed  transversely  across  the  middle  of  the  bath. 
The  actual  position  of  the  patient's  body  will  depend  on 
the  region  we  chiefly  desire  to  influence. 

The  temperature  of  the  water  is  usually  from  36°-37°  C, 
but  in  fixing  this  one  is  guided  by  the  season  of  the 
year,  the  susceptibility  of  the  patient,  and  the  nature 
of  the  disease.  An  interval  of  two  hours  should  elapse 
between  the  bath  and  a  full  meal.  If  the  current  is 
used  from  the  main,  it  should  be  switched  on  before  the 
patient  enters  the  bath,  and  not  switched  off  until  he  has 
quitted  it. 

It  is  always  best  to  make  a  trial  of  the  whole-bath 
circuit  and  to  have  a  current  of  four  or  five  milh amperes 
flowing  before  the  patient  enters  the  bath,  to  avoid  the 
possibility  of  a  hitch,  and  alarming  the  patient  when  he 
is  once  in  the  water.  The  strength  of  the  current  may 
be  gauged  by  the  attendant  placing  a  hand  in  the  water 
at  either  end  of  the  bath. 

The  patient  having  entered  the  bath  and  settled  into  a 
suitable  and  comfortable  position,  the  current  is  gradually 
increased,  care  being  taken  to  increase  and  decrease  slowly 
and  uniformly,  as  sudden  changes  may  give  the  patient  an 
unpleasant  shock.  A  qualified  ph3'sician  or  well-trained 
electrician  should  always  be  in  charge.     If  the  current  be 


212  NATURAL     THERAPY 

from  the  main,  special  caution  is  needed,  and  complete 
.insulation  and  a  reliable  rheostat  essential.  The  taps 
supplying  the  water  should  not  be  in  contact  with  the 
bath  itself,  and  the  waste-pipe  must  he  insulated  e'ffectively 
(see  page  175,  Fig.  78). 

Further,  while  the  patient  is  in  the  bath  the  waste-pipe 
should  not  be  used  to  run  off  any  water,  nor  should  fresh 
water  be  added  except  from  a  pail  or  beaker  of  some  sort. 
The  patient  must  be  warned  on  no  account  to  touch  the 
water-tap  or  electric  switch  with  his  hand  while  in  the  bath, 
for  he  might  thus  make  a  short  circuit  and  receive  a  severe 
shock. 

As  regards  actual  current  strength  employed,  no  definite 
rule  can  be  given  or  any  amount  specified  ;  each  case 
must  be  judged  on  its  own  merits. 

Too  powerful  a  current  will  soon  produce  faintness  in  the 
patient.  The  current  passing  through  the  patient  is  less 
when  the  water  contains  salt,  as  the  conductivity  of  the 
water  is  thereby  increased.  The  amount  of  the  current 
taken  up  by  the  patient's  body  will  vary  with  the  tempera- 
ture of  the  water,  its  volume  and  resistance,  and  the  specific 
resistance  and  position  of  the  body  itself.  It  varies  from  25 
to  50  per  cent  (Hedley). 

Duration  of  the  Bath. — This  varies  from  ten  to  twenty 
minutes.  After  leaving  the  bath  the  patient  should  be 
carefully  dried,  and  should  rest  for  a  little  on  a  couch.  He 
will  feel  refreshed  and  invigorated  in  a  short  time,  and 
experience  a  pleasing  sensation  of  hien  etre  and  exhilaration. 
Appetite  is  increased,  and  there  is  considerable  increase 
of  sexual  desire.  The  pulse-rate  is  lowered  by  some  8-20 
beats,  and  with  this  the  blood-pressure  falls  somewhat, 
while  metabolism  is  stimulated. 

Therapeutic  Indications. 

Neurasthenia,  hypochondriasis,  and  nervous  diseases 
with  tremor,  such  as  chorea  and  paralysis  agitans,  gout, 
chronic  rheumatism  and  rheumatoid  arthritis,  sciatica, 
and  some  ansemias  are  benefited  in  greater  or  less  degree 
by  a  course  of  baths.  Not  less  than  half  a  dozen  should 
be  taken  if  any  tangible  improvement  is  expected. 


PLATE    XXIX 


The  "Ergos"   Static    Machine. 


STATIC    ELECTRICITY 


213 


FRICTIONAL    OR    STATIC    ELECTRICITY. 

The  best-known  types  of  static  machines  are  those  of 
Holtz  and  Wimshurst.  The  difficulty  with  them  is 
the  uncertainty  of  their  action  ;  in  a  damp  atmosphere 
it  is  sometimes  extremely  difficult  to  get  them  to  work 
satisfactorily  or  at  all. 

One  of  the  most  reliable  machines  on  the  market  is  the 
"  Ergos,"  made  by  Dean.  The  maker  claims  for  this  that 
at  all  equal  velocities  it  will  produce  50  per  cent  more  current 
than  any  other  static  machine  of  the  same  plate  diameter. 
The  special  point  which  has  been  kept  in  view  in  design- 
ing the  machine  is  to  obtain  a  synchronous  speed  for  all 
the  plates.      It  is  found   that   when   all  the  plates  revolve 


Fti;.    no. — Electro-static  machine  of  Wimshurst  type  (in  air-tight  case) 

with  one  velocity,  a  much  slower  speed  will  produce  a 
maximum  voltage.  The  machine  is  driven,  not  by  a  belt 
but  on  the  chain-and-sprocket  principle.  It  can  be  worked 
by  an  electric  or  water  motor.  The  plates  are  of  ebonite 
and  are  sectionless,  varying  from  20  to  24  inches  in 
diameter.  Every  plate  can  be  quickly  detached  and  cleaned, 
or  adjusted  if  buckled.  The  number  of  plates  varies  from 
six  to  twenty-four  {Plate  XXIX). 

Dr.  Lewis  Jones  has  lately  introduced  a  reliable  form  of 
static  machine  with  eight  plates,  made  of  glass  or  vulcanite. 
Glass  plates  are  apt  to  break,  but  are  made  in  sections,  so 
as  to  be  easily  removed  for  cleaning. 


214  NATURAL    THERAPY 

A  higher  speed  is  permitted  with  safety  when  the 
vulcanite  plates  are  used.  These  vary  in  size  from  i^  to 
3  feet  in  diameter.  They  are  mounted  on  steel  tubing, 
arranged  on  the  cantilever  principle,  which  forms  a  very 
firm  and  rigid  stand.  The  machine  is  placed  inside  an 
air-tight  case  and  worked  by  hand  or  a  small  motor, 
by  a  shaft  carried  through  the  side  of  the  case  {Fig.  no). 
The  current  from  the  main  is  used,  a  rheostat  of  175  ohms 
resistance  being  interposed  to  suitably  regulate  the  voltage. 
The  case  is  perfectly  dust-proof,  and  the  contained 
air  is  kept  dry  by  means  of  small  jars  containing  chloride 
of  lime. 

The  disadvantage  of  enclosing  a  machine  in  a  case  is  that 
ozone  is  given  off  and  exercises  a  destructive  action  on 
vulcanite  plates.  To  avoid  this  there  are  various  devices. 
The  case  can  be  filled  with  CO.  from  a  cylinder,  or  fresh 
air  can  be  constantly  driven  in  by  means  of  a  fan  worked  by 
the  same  motor  which  runs  the  machine. 

A  small  platform  of  wood  with  glass  pegs  is  used  to 
seat  the  patient  upon,  and  this  is  connected  to  the  machine 
by  a  rod  with  a  hook  to  catch  on  to  either  of  the  poles. 
Metallic  groundings  (gas  and  water  pipes  will  do)  must  be 
available  for  the  electrodes  ;  if  these  pipes  are  not  available, 
two  separate  pieces  of  iron  tubing  must  be  driven  into  the 
ground  deep  enough  to  reach  subsoil  water,  and  these  must 
be  connected  by  copper  wire. 

Insulated  Platform. — The  platform  on  which  the  patient 
is  seated  for  treatment  must  be  about  3+  by  2  feet 
in  size,  strongly  made,  and  completely  insulated.  All 
corners  should  be  rounded  off  and  left  smooth.  The  glass 
legs  should  be  about  12  in.  long.  It  is  well  to  have  a  beading 
round  the  platform  to  prevent   the  chair  slipping  off. 

Electrodes. — Those  principally  used  are  the  single  point, 
multiple  point,  the  knob  electrode,  and  the  roller.  The 
two  first  are  for  the  "  static  breeze  "  ;  the  roller  is  for 
sparking  through  the  patient's  clothing,  and  so  used  is 
a  highly  stimulating  method.  Satisfactory  conductors 
must  be  provided  from  the  active  pole  to  the  patient, 
who  must  be  seated  on  the  platform  before  mentioned, 
and  have  no  contact  of  any  kind  with  the  ground  (see 
Figs.   111-116). 


STATIC    ELECTRICITY 


215 


Methods  of  Application  : — 

I.  Positive  Electrification. — This  is  a  continuous  process. 
The  patient  being  seated  as  described,  no  part  of  his  body 
should  be  nearer  the  negative  pole  than  two  feet.  The 
pole  should  be  grounded,  and  the  metal  plate  under  the 
patient's  feet  connected  with  the  positive  pole. 


FjV.  Ill, — Metal  Wire  Fig.  H2. — Point  Electrode  Fig.  113. — Knob 
^  ^Bnish  Electrode.  (Hesse's).  Electrode. 


Fig.  115. — Roller 
,^^^^^^^^^^^^^^^^^^^^^^.  Electrode. 

Fig.  116. — Bisserie's  Regulating  Handle. 

2.  Negative  Electrification. — Arrangements  are  just  the 
same,  mutatis  mutandis. 

3.  Oscillatory  General  Electrification  {Interrupted). — The 
patient  must  place  his  bare  feet  upon  a  reservoir  electrode 
filled  with  warm  water,  and  must  be  arranged  as  in  (i). 
A  large  brass    spherical    electrode    must    be   fixed   in  the 


216 


NATURAL     THERAPY 


movable  standard  and  placed  near  the  positive  pole,  so 
that  the  ball  of  the  electrode  and  the  rod  with  crook  touch 
each  other.  The  electrode  should  be  grounded  to  the  gas 
fixture.  The  head  breeze  electrode  should  be  arranged  about 
three  feet  from  the  patient  and  connected  with  the  same 
chain  which  connects  the  negative  pole  to  the  water  pipe. 

The  machine  is  started  in  action  and  the  ball  electrode 
withdrawn  with  one  hand  from  the  crook,  such  a  spark 
being  produced  as  causes  a  gentle  thrill  to  the  patient 
with  oscillation  in  his  hair. 

4.  Positive  Static  Breeze. — The  patient  is  arranged  as 
for  (2).  For  a  stationary  breeze  the  brass-pointed  electrodes 
should  be  fixed  on  the  standard  at  a  suitable  distance  from 
the  part  to  be  treated.  For  a  vertex  head  breeze,  the 
hinged  rod  at  the  top  may  be  used  ;  it  should  be  fixed  over 
the  patient's  head  and  a  wire-brush  electrode  adapted  to  it. 


Fig.  117. — Massage  Roller  Electrode. 

5.  Negative  Static  Breeze. — The  same,  with  negative  pole 
in  place  of  positive. 

6.  Moving  Positive  Breeze. — The  pointed  electrode  should 
be  attached  to  a  chain,  the  end  of  which  should  be  fixed  to 
the  gas  bracket  in  order  to  guard  it,  and  then  swept  over 
the  body  at  a  suitable  distance. 

7.  Positive  and  Negative  Spray. — An  intensified  breeze 
application.  The  patient  is  arranged  as  in  (4),  but  the 
electrode  is  nearer  the  patient,  so  that  there  is  a  visible 
shower  of  electrified  particles. 

8.  Massage  Roller  Application. — The  chain  is  attached 
to  either  the  positive  or  negative  pole,  the  electrode 
{Fig.  117)  applied  to  the  insulated  patient,  and  the  opposite 
pole  grounded.  The  intensity  of  the  application  depends 
on  the  distance  between  the  two  shding  poles. 


STATIC     ELECTRICITY  217 

9.  Positive  Static  Sparks. — The  patient  should  be  arranged 
as  for  (2).  The  large  brass  electrode  is  brought  near  the 
patient,  and  a  large  spark,  i  in.  to  6  in.  long  (percussive 
spark),  or  a  series  of  minute  frictional  sparks  drawn. 

Static  electricity  is  a  most  valuable  therapeutic  agent, 
one  of  the  most  reliable  we  possess  in  the  domain 
of  electricity.  It  has  the  effect  of  increasing  the  body- 
weight,  promoting  oxidation  processes,  increasing  the 
flow  of  urine  and  amount  of  urea  thrown  out  ;  the 
patient  feels  more  vigorous,  has  a  steady  pulse,  and  both 
eats  and  sleeps  better.  Both  the  nerves  and  muscles 
are  stimulated.  General  nutrition  is  promoted  by  general 
positive  electriiication,  potential  alternation,  breeze  spray, 
and  spark  application.  The  positive  spray  has  a  sedative 
effect. 


218 


CHAPTER     XIV. 

HIGH-FREQUENCY    CURRENTS. 

n^HESE  currents  are  characterized  by  an  exceedingly 
-^  high  E.M.F.  and  alternations  of  very  great  rapidity ; 
both  being  much  greater  than  in  currents  developed  from  a 
dynamo  or  induction  coil.  Their  voltage  may  be  as  great 
as  one  milhon,  and   their    frequency   several    milhons,    as 


Fig.    ii8, — The  IVArsonval  Transformer, 


compared  with  the  40,000  or  50,000  volts  of  an  ordinary 
induction  coil.  The  oscillating  character  of  the  discharge 
of  the  Leyden  jars  used  is  the  cause  of  the  high  frequency, 
which  is  so  great  as  to  be  unapproachable  by  the  use 
of  any  mechanical  device. 


HIGH-FREQUENCY     CURRENTS         219 

The  Production  of  High-Frequency  Currents. — The 
following  apparatus  {Plate  XXX)  are  necessary  for  high- 
frequency  treatment  :— 

I.  A  spark  coil  such  as  is  used  for  producing  Roentgen 
rays  ;  any  coil  giving  sparks  of  10  in.  or  more  will  do  very 
well,  provided  it  is  fitted  with  one  of  the  modern  inter- 
rupters, i.e.,  a  Wehnelt,  a  Mackenzie  Davidson,  or  Beclerc's 
coal-gas  mercury  break. 

If  the  alternating  current  from  the  main  is  available, 
spark  coils  can  be  used  without  any  interrupter,  or  a  step-up 
transformer  can  be  used  instead  of  the  spark  coil.     The 


Fig.  II). — The  Oudin  Resonator. 

coil  or  transformer  are  the  sources  of  the  electric  supply 
required  to  charge 

2.  Two  Leyden  jars  with  an  adjustable  spark  gap  and 
a  solenoid.  This  combination  is  usuall\'  called  d'Arsonval's 
transformer  (F^'g.  118). 

3.  In  most  cases  Oudin's  resonator  [Fig.  119)  will  be  found 
very  useful,  and  for  treating  skin  diseases  it  is  absolutely 
necessary.  This  consists  of  200  feet  of  copper  wire  wound 
round  a  large  framework  of  insulating  material.  If  a  suitable 
length  of  the  wire  be  placed  in  parallel  with  a  solenoid,  the 


220  NATURAL     THERAPY 

resonator  acts  like  the  sounding-board  of  a  musical  instru- 
ment, and  vibrates  in  unison  with  the  solenoid,  so  as  greatly 
to  increase  the  E.M.F.  The  two  being  in  proper  accord, 
the  upper^  turns  and  terminal  of  the  resonator  discharge  a 
very  powerful  violet  effleuve  (best  seen  in  a  darkened  room). 
The  resonator  should  have  a  sliding  contact  to  which  the 
wire  from  the  one  end  of  the  solenoid  can  be  attached,  and 
the  contact  is  moved  up  and  down  until  the  desired  results 
are  obtained.  The  most  correct  adjustment  is  produced 
when  the  resonator  can  be  rotated.  Sometimes  the  solenoid 
is  dispensed  with  entireh^  and  the  lower  turns  of  the 
Oudin  take  its  place.  Without  the  resonator  the  most 
usual  method  of  producing  high-frequency  current  is  to 
allow  Ley  den  jars  to  discharge  through  the  primary  coil  of 
an  induction  apparatus,  such  as  d'Arsonval's  bipolar 
induction  coil. 

Instead  of  Oudin's  resonator,  a  Tesla  transformer  may 
be  used  for  raising  the  E.M.F.  These  transformers  are 
usually  submerged  in  oil,  but  can  be  also  made  for  insulation 
in  air  only  ;  in  the  latter  case  they  are  more  bulky.  A 
great  quantity  of  ozone  is  generated  by  the  effleuve  from 
the  Oudin  resonator  or  the  Tesla  transformer. 

4.  Either  a  solenoid  to  enclose  the  patient,  or  a  condenser 
couch,  or  some  electrodes  for  local  application,  and  a  pair 
of  heavily  insulated  cables  to  conduct  the  current,  are  also 
required. 

The  current  strength  is  regulated  partly  by  varying  the 
current  in  the  primary  of  the  spark  coil  or  transformer,  and 
partly  by  adjusting  the  length  of  the  spark  gap,  and  by 
inserting  more  or  less  turns  of  the  solenoids  in  dArsonval's 
transformer  or  in  Oudin's  resonator. 

The  currents  are  produced  in  the  following  manner  : 
The  secondary  terminals  of  a  spark  coil  (or  an  alternating 
current  transformer)  are  connected  with  the  inner  coatings 
of  two  Ley  den  jars,  and  an  adjustable  spark  gap  is  inserted 
between  these  two  jars.  When  the  spark  coil  is  started, 
the  Leyden  jars  become  charged — one  with  positive,  the 
other  with  negative  electricity  ;  and  when  the  E.M.F.  of 
the  charge  is  sufficiently  high,  a  spark  leaps  across  the  gap. 
To  the  naked  eye  this  discharge  appears  as  one  single  spark, 
but  it  actually  consists  of  a  succession  of  extraordinarily 


HIGH-FREQUENCY     CURRENTS         221 


rapid    electrical    oscillations    or    waves.     As    long    as    the 

inner  coating  of  a  Leyden   jar   is   charged  with   positive 

electricity,    the    outer  coating    must    be    charged   with    a. 

similar   quantity   of   negative  ;    as 

soon    as   a   spark   leaps    over,    the 

charge    inside    disappears,   but   on 

account   of  the   change    the    outer 

coating  becomes  positively  charged, 

and  this  again  induces  a  negative 

charge     on     the     inside     coating ; 

plus     and    minus    have     changed 

places,    and   the    quantity    of    the 

charge  is  a  little  reduced,  but  now 

there  is  a  charge  causing  a  second 

spark  in  an  opposite  direction,  and 

this   produces   similar  results.     In 

this  way  it  continues  till  the  waves 

have  calmed  down  and  cease.     If 

the    discharge    from    a    condenser 

{Fig.  121)  is  examined  in  a  rapidly 

revolving     cylindrical     mirror,      it 

appears    as     a     conical    band    of 

gradually    diminishing    width    and 

intensity,  and  from  the  length  of 

this   band    and    the   speed   of   the 

mirror  it  has  been  calculated  that 

the  sparks  follow  one  another  in  an 

opposite  direction  with  an  interval    App'i^atus°'  ^^h^'Syto^'^'jarT 

of  about   one-millionth   part   of   a    l^^^"'"^  *p^^^  ^^p-  ^^^^o"^'"--. 

second  only.     It  is  on  account  of 

their  rapidly  oscillating  character  that  such  currents  have 

been  called  "  high-frequency  "  currents. 

As  already  mentioned,  every  change  of  potential  taking 
place  on  the  inside  coatings  induces  a  similar  change  of 
the  same  intensity  but  in  opposite  direction  on  the  outer 
coatings ;  and  the  currents  thus  generated  between  the 
outer  coatings  of  the  two  Leyden  jars  are  applied  to  patients 
in  a  manner  to  be  described  later  on. 

The  E.M.F.  of  these  oscillating  currents  can  be  raised 
by  induction  in  various  ways.  For  instance,  a  spiral  with 
a  few  turns  of   stout  copper  wire  can  be  inserted  in  the 


222 


NATURAL     THERAPY 


circuit  between  the  two  Ley  den  jars,  and  if  this  spiral  is 
placed  like  a  primary  coil  inside  a  solenoid  of  many  turns 
of  fine  wire,  a  brush  discharge,  or  sparks  similar  to  those 
from  a  large  static  machine,  are  obtained  from  the  terminals 
of  the  secondary  solenoids. 

The  chief  methods  of  applying  high-frequency  currents 
for  treatment  are  : — • 

1.  Auto-conduction. 

2.  Condensation. 

3.  Local  application  of  the  effleuve,  or  placing  the  patient 
in  circuit  by  direct  contact  with  suitable  electrodes. 


^'If^^'.'VW-'  -• 


Fig.  121. — High-Frequency  Apparatus,  with  Oil  Condenser. 

1.  In'auto-conduction  the  solenoid  is  made  large  enough 
to  contain  the  patient  without  contact,  and  the  patient 
steps  inside,  either  standing  or  reclining  {vide  supra), 
according  to  whether  the  solenoid  is  vertical  or  horizontal. 
The  patient  forms  the  secondary  of  a  gigantic  induction 
coil,  and  will  be  the  seat  of  induced  currents.  The  danger 
of  and  objection  to  this  method  is  cross  sparking,  which 
greatly  alarms  nervous  patients. 

2.  In  condensation  the  patient  forms  one  of  the  plates 
of  a  condenser  or  Leyden  jar.  A  couch,  the  lower  back 
part  of  which  is  lined  with  a  metal  plate,  is  provided.  It 
carries  a  terminal  by  which  it  may  be  attached  to  the  Oudin 
or  one  end  of  the  solenoid.     The  metal  is  covered  with  felt 


HIGH-FREQUENCY     CURRENTS 


223 


or  asbestos,  and  on  this  cushions  are  placed.  The  patient 
rechnes  on  the  couch,  and  is  connected  with  the  earth  or 
other  end  of  the  solenoid  by  grasping  an  electrode  attached 
to  a  chain,  the  other  end  of  which  may  pass  to  a  gas-pipe, 
or  to  the  solenoid,  or  both.  The  felt  and  cushions  constitute 
the  di-electric  (like  the  glass  of  the  Ley  den  jar),  and  the 
patient  the  outer  or  earth-contact  coating  of  the  condenser. 
Every  oscillation  results  in  the  patient  being  charged  and 
discharged,  the  charges  being  alternately  positive  and 
negative. 

3.  The  Effleuve. — A  pointed  electrode,  with  insulated 
handle,  connected  with  the  Oudin  resonator,  is  brought  near 
to  the  patient.     As  it  approaches,  a  violet  spark,  the  effleuve, 


4' 


9^ 


'-^ 


Fig.  122. — Glass  "  Condensing  "  Electrodes. 

starting  from  both  the  point  and  the  patient,  completes 
the  circuit.  The  form  of  the  spark  resembles  the  lines  of 
force  between  two  magnetic  poles.  Too  close  approxim- 
ation will  result  in  the  passage  of  sparks  which  are  painful 
to  the  patient. 

If  the  pointed  electrode  is  enclosed  in  a  glass  tube,  it  is 
called  a  condensing  electrode  {see  Fig.  122).  This  is  a  milder 
form  of  the  effleuve  ;  it  may  be  safely  allowed  to  touch  the 
skin  and  will  only  cause  a  slight  tingling  sensation. 

As  an  alternative,  the  patient  may  be  interpolated  in  the 
circuit  by  firmly  applying  two  large  surface  electrodes, 
attached  either  to  the  two  ends  of  the  solenoid,  or  one  to 
the  solenoid  and  the  other  to  the  resonator. 


224 


NATURAL    THERAPY 


The  effleuve  is  the  only  form  of  high-frequency  current 
causing  the  patient  any  appreciable  sensation.  Slight 
smarting  or  tingling  is  caused,  and  local  hyperaemia,  which 
lasts  for  some  hours  or  even  days  :  cf.  mustard  plaster. 

The  strength  of  the  application  is  graduated  in  the 
following  manner : — 

1.  The  primary  current  of  the  coil  is  altered  in  strength  or 

voltage. 

2.  The  sparking  gap  is  made  smaller  or  larger — the  longer 

the  spark  the  stronger  the  oscillations. 

3.  The    current   strength   will   vary    with   the   accuracy    of 

tuning  of  the  resonator  to  the  solenoid. 


Fig.  123. — Portable  High-rrcquency  apparatus,  worked  by  an  Accumulator. 

Currents  of  three  amperes  and  more  pass  through  patients 
without  discomfort  or  pain  or  even  sensation,  and 
d'Arsonval  attributes  this  immunity  to  the  tissues  being 
incapable  of  responding  to  such  rapid  alternations,  just 
as  the  human  ear  does  not  respond  to  sound  vibrations 
more  frequent  than  40,960  per  second  (Preyer).  Above 
5,000  vibrations  per  second  the  effect  on  the  tissues  steadily 
diminishes. 

As  a  result  of  the  application,  the  blood-pressure  falls, 
and  more  CO2  is  eliminated  and  more  oxygen  absorbed  by 
the  blood.  Waste  products  are  more  rapidly  excreted  by 
the  kidneys,  and  there  is  some  increase  in  heat  production. 


HIGH-FREQUENCY    CURRENTS 


225 


Fig.  124. — Hot-wire  Jlilliamperemeter. 


Measuring  the  Current. — The  strength  of  the  current 
will  depend  on  the  width  of  the  spark  gap,  but  can  also  be 
graduated  by  regulating  the  current  from  the  induction 
coil  which  supplies  the  Ley  den  jars. 

Fig.  124  illustrates  a  hot- 
wire milliamperemeter  for 
measuring  the  current.  The 
strength  used  in  high- 
frequency  applications  varies 
from  100  to  800  milliamperes. 
or  even  more  by  some 
operators. 

In  auto-conduction  the  full 
power  of  the  machines  is 
commonly  employed,  but 
measurement  cannot  be 
made.  In  condensation  the 
galvanometer  is  placed  be- 
tween the  patient  and  his  point  of  attachment,  and  in  local 
applications  it  should  be  in  series  with  the  patient.  In 
brush  discharges  the  appearance  of  the  effleuve  is  a  guide 
to  the  current  strength. 

Therapeutic    Ixdicatioxs. 

Great  attention  has  been  given  of  late  years  to  high- 
frequency  both  in  Great  Britain  and  on  the  Continent. 
While  possibly  there  has  been  a  tendency  in  certain  quarters 
to  exaggerate  the  value  of  the  currents,  there  is  certainly 
no  justilication  for  the  ultra-scepticism  which  is  displayed 
by  physicians  in  regard  to  their  therapeutic  value,  and  the 
term  "  quackery  "  is  quite  inapplicable  to  their  reasonable 
and  judicious  employment.  Granting  that  the  effleuve  is 
but  an  elegant  and  somewhat  expensive  form  of  linimentum 
A. B.C.,  or  mustard  plaster,  it  is  unquestionably  a  most 
efficient  counter-irritant,  and  it  is  generally  conceded  by 
those  with  experience  in  electrotherapy  that  auto-conduction 
and  auto-condensation  are  a  valuable  means  of  reducing 
high  blood-pressure.  x\  S3'mpathetic  vibration  of  the 
electrons  appears  to  be  set  up  by  the  rapid  changes  in  the 
magnetic  field.  The  stimulation  or  inhibition  of  the  nerve 
centres    will    depend    on    the    rapidity  of    this   vibration. 

15 


226  NATURAL     THERAPY 

Simultaneous  stimulation  of  the  vasodilator  and  inhibition 
of  the  vasocontractor  centres  may  thus  be  obtained  at  cne 
and  the  same  time.  To  actual  stimulation  of  the  vaso- 
dilator centres  is  probably  due  the  powerful  action  of  high- 
frequency  currents  on  the  renal  secretion. 

Doubtless  too  much  has  been  claimed  for  high-frequency 
treatment,  and  to  vaunt  it  as  a  panacea  for  all  nervous  ills 
is  the  sheerest  nonsense.  At  the  same  time  there  seems 
no  sufficient  reason  why  we  should  refuse  to  employ  it  in  the 
treatment  of  the  hysterical  and  neurotic  who  declare  they 
feel  benefited  by  a  seance.  The  professed  object  of  a 
physician  is  to  cure  disease,  and  when  a  patient  suffering 
merely  from  functional  ailments  or  neuroses  comes  before 
him,  having  tried  many  other  physicians  and  drugs  without 
benefit,  there  is  surely  no  justification  for  refusing  such  an 
one  the  trial  of  a  mode  of  treatment  which  appeals  to  his 
imagination  and  in  which  he  thoroughly  believes. 

The  Effect  of  High-frequency  Currents  on  the 
Blood -Pressure. — There  seems  to  be  no  reasonable  doubt 
that  a  course  of  high-frequency  treatment  by  auto-conduc- 
tion or  the  condenser  couch,  or  even  the  application  of 
the  effleuve,  has  a  considerable  effect  in  reducing  blood- 
pressure.  Moutier  has  recorded  a  reduction  of  as  much 
as  30  mm.  of  mercury  at  a  sitting,  and  Wilfred  Harris 
has  frequently  found  a  drop  of  20  mm.  at  a  sitting  as 
ascertained  by  a  Riva-Rocci  sphygmomanometer.  Lewis 
Jones,  Herschell,  and  even  Clifford  Allbutt,  speaking 
as  a  physician  and  not  an  electrical  physician,  agree, 
that  in  the  high-frequency  currents  we  have  a  valuable 
agent  in  the  treatment  of  hyperpiesis.  In  view  of  a  some- 
what widespread  scepticism  on  the  subject,  it  is  well  to 
mention  these  authorities. 

It  is  hardly  to  be  expected  that  long-standing  arterial 
changes  can  be  removed,  or  the  "  ipecacuanha-root  artery  " 
rendered  elastic  by  any  form  of  electrical  treatment,  but  in 
early  cases  of  hyperpiesis  and  arterial  thickening  there 
seems  every  reason  to  look  hopefully  for  improvement 
when  high-frequency  currents  are  applied.  It  is  well 
known  that  these  conditions  are  often  very  resistant  to  any 
sort  of  drug  treatment,  and  therefore  a  method  with  any 
promise  surely  deserves  an  extended  trial. 


HIGH-FREQUENCY     CURRENTS         227 

The  condensation  couch  seems  to  exercise  a  general  tonic 
effect  on  debihtated  patients,  and  paradoxical  as  it  may 
seem  in  view  of  the  remarks  above,  abnormally  low  pressure 
is  sometimes  raised,  with  improvement  of  the  patient's 
general  condition. 

Painful  hssure  of  the  anus  readily  yields  tothis  treatment 
in  many  instances.  It  has  been  known  for  several  years 
that  the  H.F.  currents  beneficially  affected  this  condition. 
Frenkel,  writing  lately  on  the  subject,  says  not  only  has 
this  proved  to  be  the  case,  but  he  has  found  incidentally 
that  the  constipation  which  so  often  co-exists  and  aggravates 
this  affection  is  quickly  and  easily  cured  at  the  same  time. 
He  treated  a  score  or  more  cases  of  constipation  in  this 


Fig.  125.- — The  Effect  of  High-frequency  Currents  on  the  Pulse-tracing  : 
{a)  Before  treatment,  (b)  After  treatment. 

way  and  found  improvement  in  each.  The  application 
was  made  with  a  unipolar  connection,  no  volts,  a  cylindrical 
or  conical  electrode  being  used.  The  seance  lasted  fifteen 
minutes. 

Apart  from  the  very  numerous  neurotics  who  are  often 
benefited  to  a  marked  degree  by  high-frequency  treatment, 
the  currents  have  been  employed  with  good  result  in  cases  of 
gout,  rheumatism,  rheumatoid  arthritis,  diabetes  mellitus 
and  insipidus,  obesity,  tuberculous  disease,  gastric  atony 
and  dilatation,  neuritis,  and  diseases  of  the  spinal  cord,  e.g., 
amyotrophic  lateral  sclerosis  and  progressive  muscular 
atrophy,  and  some  skin  diseases  (eczema,  pruritus,  lupus, 
alopecia  areata,  etc.). 


228  NATURAL     THERAPY 

In  tuberculous  diseases,  the  current  appears  to  possess 
some  curative  action.  The  bacillus  is  unable  to  resist 
repeated  applications,  and  the  reproductive  power  and 
virulence  of  the  toxins  appear  to  become  weakened,  while 
the  human  organism  attacked  grows  stronger  (Riviere). 
The  flow  of  the  blood-  and  lymph-streams  is  accelerated, 
and  oxidation  is  favoured,  so  that  toxins  are  the  more  readily 
eliminated.  Phagocytosis  is  more  active  with  alexins  in 
free  supply.  The  patient's  resistance  to  the  inroads  of  the 
disease  is  thus  markedly  increased.  A  number  of  cases 
of  pulmonary  consumption  appear  to  have  derived  benefit 
from  the  application  of  the  efileuve  to  the  apex,  in  the 
hands  of  Chisholm  Williams,  Riviere,  Chowry-Muthu,  and 
others. 


229 


Section  V. — Diet  in  the  Treatjuent  of 
Disease. 


CHAPTER    XV. 


GENERAL     PRINCIPLES 
AND     COMPOSITION     OF     FOOD. 

T^IETETICS  consists  in  the  study  of  the  substances 
-*-^  which  serve  for  food,  and  the  process  of  nutrition 
in  health  and  disease. 

All  living  creatures  derive  their  nourishment  from  the 
vegetable  kingdom,  either  directly,  or  indirectly  by  living 
upon  animals  which  in  their  turn  subsist  on  vegetables. 
Foods  are  the  substances  which  are  required  for  the  nutrition 
and  maintenance  of  the  body  and  for  the  replacement  of 
its  wastes  and  losses. 

In  connection  with  the  nutrition  of  a  healthy  man,  we 
find  that  there  is  great  variety  in  the  nature  and  quality 
of  the  food  substances  used,  as  well  as  in  the  quantity 
consumed,  by  different  individuals.  Nevertheless,  the 
three  main  elements  in  all  descriptions  of  human  sustenance 
are  albumin,  carbohydrates,  and  hydrocarbons,  to  which 
may  be  added  water. 

Vegetarians,  such  as  Hindoos,  derive  most  of  their 
sustenance  from  the  vegetable  kingdom,  while  Guachos, 
Esquimaux,  and  others  live  almost  entirely  on  animal  food. 
The  happy  and  safe  medium  lies  between  these  two  ex- 
tremes, and  the  highest  dietetic  authorities,  such  as  Voit, 
Pettenkofer,  Chittenden,  and  Pavy,  recommend  a  mixed 
diet  of  animal  and  vegetable  food.  In  this  connection 
Rudolf    Virchow    remarked,    "  Although    the    Esquimaux 


230  NATURAL    THERAPY 

and  Kirghiz  show  us  that  hfe  and  health  can  be  maintained 
for  many  generations  on  an  exclusively  nitrogenous  diet,  and 
other  tribes  such  as  the  Hindoos  live  almost  entirely  on 
non-nitrogenous  food,  yet  history  shows  us  that  the  highest 
attainments  of  the  human  race  have  emanated  from  nations 
who  have  lived  and  do  live  on  mixed  diets.  A  mixed  diet 
taken  partly  from  the  animal  and  partly  from  the  vegetable 
kingdom  is  the  most  suitable  and  digestible  form  of  nourish- 
ment for  mankind." 

We  derive  the  greatest  amount  of  carbohydrates  from 
the  vegetable  kingdom,  while  much  albumin  is  derived 
from  animal  food.  The  proportion  of  vegetable  to 
animal  albumin  in  our  food  should  be  as  three  to  seven 
(Uffelman). 

The  larger  portion  of  the  food  we  consume  is  employed 
to  generate  the  heat  necessary  for  the  maintenance  of  life, 
only  a  small  portion  going  to  make  up  for  tissue  waste. 
Food  being  thus  intimately  concerned  in  the  production  of 
heat,  it  is  customary  to  speak  of  food  in  terms  of  its  heat- 
producing  capacity.  A  heat  unit  is  the  quantity  of  heat 
required  to  raise  the  temperature  of  i  cc.  of  water  i°  C. 
The  term  commonly  employed  in  calculating  food  energy 
is  "  great  heat  unit,'"  or  calorie,  by  which  is  meant  that 
quantity  of  heat  energy  which  is  required  to  raise  the 
temperature  of  i  kilogram  of  water  i°  C.  Each  kind  of  food 
is  ultimately  oxidized  in  the  body  to  its  end-products,  and 
for  the  most  part  exhaled  in  the  form  of  CO,  gas  ;  the 
more  carbon  atoms  it  contains  the  more  heat  will  it  generate  ; 
thus  I  gram  of  fat  generates  9-3  calories,  i  gram  of 
carbohydrates  4-1,  and  i  gram  of  albumin  4-1  calories. 
The  quantity  of  nourishment  taken  being  ascertained, 
it  is  easy  to  determine  the  energy  value,  or  number  of 
calories  introduced,  by  multiplying  the  different  types 
of  food-stuffs  by  the  above  figures.  The  amount  of 
heat  which  it  is  requisite  for  the  body  to  generate 
daily  for  its  maintenance  has  been  estimated  at  2,500 
units  (Koenig.) 

Von  Noorden  gives  the  caloric  value  of  food  taken  by 
the  average  working  man  as  40  units  per  kilogram  of 
body-weight  per  day,  when  working,  and  as  34  units  when 
resting. 


COMPOSITION     OF    FOOD 


231 


By  the  following  tables  it  is  a  simple  matter  to  calculate, 
approximately,  whether  a  given  quantity  of  food  constitutes 
an  adequate  diet  or  unit. 

COMPOSITION    OF    COMMON    ARTICLES 
OF    FOOD     (after    Einhorn). 


I.     Dairy  Products. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Cow's  Milk 

1 

4-4-3 

3-3-8 

37 

64 

Cream    .  . 

3-6i 

26-75 

3-52 

276-01 

Butter    .  . 

O-K 

90-0 

0-5 

837 

Whey      .  . 

0-5 

0-3 

3-6 



Buttermilk 

3-0 

1-3 

3-0 

3-67 

Koumiss 

3'35 

2-07 

3-0 

33-99 

Cream  Cheese  . 

25 

30-0 

3-0 

394 

Cheese    .  . 

33 

9-0 

5-0 

240 

Eggs       .  . 

12-5 

I2-0 

0-5 

165 

II.     Meats  and  Game. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Beef  (fat) 

17-19 

26-38 



315-81 

Beef  (lean) 

2O-7S 

1-50 

— 

99-15 

Veal  (fat) 

18-88 

7-41 

0-07 

146-61 

Veal  (lean) 

19-84 

0-82 



86-97 

Mutton       (very 

fat)      .  . 

14-80 

36-39 

0-05 

399-31 

jNIutton  (leaner) 

17-II 

5-77 

— 

123-81 

Pork  (fat) 

14-54 

37-34 



406-88 

Pork  (lean) 

20-25 

6-8i 

— 

146-39 

Ham 

23-97 

36-48 

1-50 

453-69 

Sweetbread 

22-0 

0-4 



93-92 

Pulverized  Meat 

64-5 

5-24 

2-28 

322-53 

Poultry 

22-0 

1-0 

— 

loo- 

Spring  Chicken 

18-49 

9-34 

I-20 

167-59 

Duck  (wild)      .  . 

22-65 

3-11 

2-33 

131-36 

Game 

23-0 

i-o 

103-60 

Hare 

23-34 

1-13 

0-19 

107-08 

Venison 

19-77 

1-92 

1-42 

105-44 

232 


NATURAL     THERAPY 


III.     Fish. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Pike 

18-5 

0-5 

0-75 

83-57 

Carp 

20-6l 

1-09 

— 

94-64 

Shellfish 

17-09 

9-34 

— 

156-93 

Salmon  .  . 

15-01 

6-42 

2-85 

132-93 

Oysters 

4-95 

0-37 

— 

24 

Salt  Herring     .  . 

;      19-5 

17-0 

0-5 

— 

Caviare  .  . 

28-04 

16-26 

7-82 

— 

IV.  Cereals  and  Vegetables. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Sago 

0-5 

traces 

86-5 

356-70 

Wheat  Flour     . 

8-5 

1-25 

73-0 

34578 

Rye  Flour 

lO-O 

2-0 

69-0 

342-50 

Wheaten  Bread 

j      6-0 

0-75 

52-0 

245 

Rye  Bread 

•1         4-5 

i-o 

46-0 

216 

Roll 

J         6-82 

077 

4372 

213-87 

Zwieback 

9-5 

1-0 

75-0 

356 

Cauliflower 

.    2-0  to  5-0 

0-4 

4-0 

35 

Carrots  .  . 

I -04 

0-2I 

6-74 

33-85 

Asparagus 

2-0 

0-3 

2-5 

21 

Rice 

5-5 

1-5 

76-0 

348-10 

Beans 

19-5 

2-0 

52-0 

31175 

Peas 

19-5 

2-0 

54-0 

319-95 

Potatoes 

i'5 



20-0 

88 

Oatmeal 

12-5 

5-26 

66-77 

338-80 

Barley  Meal 

8-31 

o-8i 

75-19 

323 

Spinach 

3-49 

0-58 

4-44 

38 

Pickles   .  . 

1-02 

1 

0-09 

0-95 

— 

V.  Soups  and  Beverages. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Milk  Soup,  with 

wheat  flour  .  . 

5-0 

3-25 

15-0 

112 

Meat    Broth 

(ordinary) 

0-4 

0-6 

— 



Meat  Juice 

(pressed) 

6-0  to  7-0 

0-5 

— 

— ■ 

COMPOSITION     OF     FOOD 


233 


Soups   and   Beverages,    Continued. 


Albumin, 

Fat, 

Carbohydrate, 

Calories, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Beef  Tea 

0-5 
9-0  to  ii-o 

0-5 

— 

— 

Leube's  Meat 

albumin  ; 

Solution 

•79  to  6-5 
peptone. 

Malt  Extract    .  . 

8-0  to  lo-o 

— 

55-0 

258-30 

Barley  Soup      .  . 

1-5 

i-o 

ii-o 

60-96 

Rice  Pap,  with 

milk    .  . 

8-8 

3-5 

28-6 

182-61 

Coffee 

3-12 

5-i8 

— 

— 

Tea 

12-38 

— 

— 

— 

Beer 

0-5 

5-25 

0-3 

— 

Porter     .  . 

07 

6-0 

0-3 

60 

VI.     Fruits. 


Free  Acid, 

Albumin, 

Fat, 

Carbohydrate, 

per  cent. 

per  cent. 

per  cent. 

per  cent. 

Apples    .  . 

0-82 

0-36 

. 

7-22 

Pears 

0-20 

0-36 

— 

3-54 

Plums     .  . 

1-50 

0-40 

— 

4-68 

Peaches 

0-92 

0-65 

— 

7-17 

Grapes    .  . 

079 

0-59 



1-96 

Strawberries 

0-93 

0-54 

0-45 

I-OI 

Chestnuts 

5-48 

1-37 

38-34 

Sugar-cane 

— 

— 

— 

3 '40 

Honey    .  . 

— 

I -20 

— 

5-28 

The  average  male  adult  consumes  in  the  form  of  food 
about  120  grams  albumin,  90  grams  fats,  330  grams  carbo- 
hydrates, and  2,818  grams  water  per  day  (Vierordt). 

Eighty  grams  of  albumin  per  diem  is  said  to  be  the 
lowest  amount  consistent  with  proper  nutrition.  Food- 
stuffs are  built  up  of  these  four  elements,  and  also  contain 
small  amounts  of  certain  inorganic  salts. 


ANIMAL    FOODS. 

These  comprise  besides  the  ilesh  (muscles)  of  the  different 
mammals,  birds,  and  fishes,  several  other  portions  of  their 


234  NATURAL     THERAPY 

bodies,  as,  for  instance,  various  glands,  the  brain,  lungs, 
liver,  etc.  Oysters  and  lobsters  also  belong  to  this  group. 
In  most  instances  the  digestibility  of  this  group  of  foods 
corresponds  to  their  richness  in  fat.  The  less  fat  they 
contain  the  more  digestible  they  are.  Thus  we  have  the 
following  list  of  animal  foods  classified  according  to  their 
digestibility  : — ■ 

Fat, 
per  cent. 

Calf's  Sweetbread,  Veal,  Cod-fish,  Pike,  Oysters  0-4  to  i 

Beef,  Hare,  Spring  Chicken,  Pigeon,  Partridge,  Carp  i    .,  li- 

Mutton,  Pork    .  .           .  .           .  .           .  .           .  .           .  .  5    ..  7 

Goose,  Caviare,  Herring,  Salmon,  Eel         .  .           .  .  over  8 

The  digestibility  of  food  is  also  greatly  dependent  on  its 
quality  and  preparation.  Young  animals  have  soft  and 
tender  meat,  whereas  the  flesh  of  old  ones  is  tough.  The 
different  portions  of  an  animal  vary  in  their  digestibility. 
The  time  that  has  passed  since  the  killing  of  the  animal  is 
also  of  importance.  Fresh  meat  which  is  yet  in  its  rigid 
state  is  tough,  and  therefore  very  indigestible.  In  the 
preparation  of  the  meat  we  must  see  that  it  is  separated 
from  all  indigestible  matter  (fascia,  tendons,  cartilage).  By 
pounding  the  meat  the  connective  tissue  surrounding  the 
muscle  fibre  is  torn.  By  chopping,  scraping,  or  pulverizing 
the  meat,  its  digestibility  is  increased.  All  other  methods 
of  preparing  meat  only  serve  to  improve  its  taste ;  for  raw 
meat  is  more  easily  digested  than  that  which  has  been 
boiled,  broiled,  or  fried.  The  application  of  heat,  however, 
diminishes  the  danger  of  infection,  as  many  micro-organisms 
are  destroyed  by  it. 

Eggs  are  especially  rich  in  albumin  and  fat.  Soft-boiled 
eggs  (three  minutes  in  boiling  water)  are  easiest  to  digest. 
Then  come  raw  eggs  and  scrambled  eggs,  while  hard-boiled 
eggs  and  omelette  are  difficult  of  digestion.  Soft-boiled 
eggs  remain  in  the  stomach  one  and  three-quarter  hours, 
hard  boiled,  three  hours. 

Milk  is  intended  as  the  sole  food  of  young  animals,  and 
as  such  contains  all  the  elements  of  a  typical  diet  :  (i) 
Albuminous  substances  in  the  form  of  casein  and  serum 
albumin  ;  (2)  Fats  in  cream  ;  (3)  Carbohydrates  in  the 
form  of  lactose  or  milk  sugar  ;  (4)  Salts,  chiefly  calcium 
phosphate  ;     and   (5)  Water.     Milk   does  not   stay  in   the 


COMPOSITION     OF    FOOD  235 

stomach  much  longer  than  plain  water,  and  must  therefore 
be  considered  very  digestible. 

Several  articles  of  food  are  obtained  from  milk  : — 

(a)  Cheese,  which  is  the  casein  precipitated  with  more 
or  less  fat,  according  as  the  cheese  is  made  of  skimmed 
milk  (skim  cheese),  or  fresh  milk  with  its  cream  (Cheddar 
and  Cheshire),  or  of  fresh  milk  plus  cream  (Stilton  and 
double  Gloucester).  The  precipitated  casein  is  allowed  to 
ripen,  by  which  process  some  of  the  albumin  is  split  up 
with  formation  of  fat. 

(b)  Cream  consists  of  the  fatty  globules  encased  in  casein, 
and  which,  being  of  lowest  specific  gravity,  rise  to  the 
surface. 

(c)  Butter  is  the  fatty  matter  deprived  of  its  casein 
envelope  by  the  process  of  churning. 

(d)  Buttermilk  is  the  fluid  obtained  from  cream  after 
butter  has  been  formed.  It  is  therefore  very  rich  in 
nitrogen. 

(e)  Whey  is  the  fluid  which  remains  after  the  precipitation 
of  casein.  It  contains  sugar,  salt,  and  a  small  quantity  of 
albumin. 

VEGETABLE  FOODS. 

All  these  contain  more  or  less  carbohydrates,  and  the 
principal  amount  of  carbohydrates  of  our  diet  is  obtained 
from  them. 

1.  Foods  rich  in  Proteids. — Leguminous  foods  (peas, 
beans,  lentils,  etc.)  contain  a  nitrogenous  substance  called 
legumin  (which  is  allied  to  albumin),  in  the  proportion  of 
twenty-five  per  cent.  They  form  a  chief  source  of  the 
nitrogen  of  the  food  of  vegetarians. 

2.  Foods  rich  in  CarbohYdrates. — Cereals.  Bread  made 
from  the  ground  grain  of  various  so-called  cereals,  such  as 
wheat,  rye,  maize,  barley,  rice,  oats,  etc.,  is  the  most 
direct  form  in  which  carbohydrate  is  supplied  in  an 
ordinary  diet.  Besides  starch,  bread  contains  gluten  (a 
nitrogenous  body)  and  a  small  amount  of  fat.  \\'hite 
bread  is  easier  to  digest  than  brown.  A^arious  articles 
of  food  are  made  from  flour,  viz.,  sago,  macaroni,  and 
biscuits. 


236 


NATURAL    THERAPY 


The  following   table  gives   the  approximate  percentage 
composition  of  some  of  the  principal  foodstuffs  : — ■ 

PERCENTAGE    COMPOSITION    OF    FOODS. 


Bread 

Wheat  Flour 
Oatmeal 
Rice  .  . 
Peas  (split) 
Potatoes 
Milk  .  . 
Cheese 
Lean  Beef 
Fat  Beef 
Mutton 
Veal  .  . 
White  Fish 
Salmon 
Eggs  .  . 
Butter 


Water. 

Proteids. 

starch. 

Sugar. 

Fat. 

37 

8 

47 

3 

I 

15 

II 

66 

4-2 

2 

15 

12-6 

58 

5-4 

5-6 

13 

6 

79 

•4 

•7 

15 

23 

55 

2 

2 

75 

2 

18 

3 

•2 

86 

4 

— 

5 

3-8 

2>7 

ZZ 

— 

— 

9       i 

72 

19 



— 

3 

51 

24 

— 

— 

29 

72 

18 

— 

— 

5 

63 

16 

— 

— 

16 

78 

18 

— 

— 

3 

77 

16 

— 

— 

5-5    i 

74 

14 

— 

— 

12            ! 

15 

— 

— 

— 

S3 

Salts. 


2 

17 

3 

•5 
2 

•7 
•8 

5 
5 
4 
5 
4 
I 

1-5 
1-5 
2 


THE    INFLUENCE    OF    COOKING    ON    THE 
DIGESTIBILITY    OF    CERTAIN     FOODS. 

Raw  flesh  has  only  one  inconvenience — it  sticks  to  the 
teeth,  otherwise  it  is  not  at  all  unpleasant  to  taste.  Seasoned 
with  a  little  salt,  it  is  easily  digested,  and  must  be  at  least 
as  nourishing  as  in  any  other  form.  Man  is  a  cooking 
animal,  but  broadly  it  may  be  stated  that  most  forms  of 
cooking  actually  lessen  the  digestibility  of  animal  foods, 
rendering  them  in  some  cases  tough  and  leathery, 
whilst  they  increase  that  of  vegetable  foods.  It  is  a 
clinical  fact  that  many  patients  can  take  raw  or  greatly 
underdone  meats  more  easily  than  other  forms  of  nourish- 
ment. This  lessening  of  the  digestibility  of  animal  foods 
by  cooking,  regarded  clinically,  is  in  a  measure  made 
up  for  by  advantages  in  their  improved  appearance  and 
greater  attractiveness,  and  by  the  new  flavours  develop- 
ed in  them  serving  to  stimulate  the  secretion  of  gastric 
juice.     They    are    also    wholly    or    partly    sterilized.     The 


COMPOSITION     OF     FOOD  237 

general  effect  of  cooking  on  the  structure  of  meat  is  to 
loosen  its  fibres  by  converting  into  gelatin  the  connective 
tissue  which  holds  them  together,  and  to  remove  fat ;  the 
chief  effect  on  the  chemical  composition  of  meat  is 
to  diminish  the  amount  of  its  water.  That  meat  is 
rendered  less  digestible  in  proportion  to  the  degree  of 
cooking  it  undergoes  is  shov/n  by  the  fact  that  3^-  ounces 
of  beef,  taken  raw,  disappear  completely  from  the  stomach 
in  2  hours  ;  if  half-boiled,  in  2?r  hours  ;  if  wholly  boiled, 
in  3  hours  ;  if  half  roasted,  in  3  hours,  and  if  wholly 
roasted,  in  4  hours. 

The  effect  of  heat  on  the  proteids  of  food  is  to  coagulate 
them,  which  is  effected  at  a  temperature  of  about  77°  C. 
If  the  temperature  reached  in  cooking  be  beyond  this, 
the  value  of  the  food  is  lessened  by  the  hardening  and 
shrinking  of  the  proteid  materials.  The  value  of  this  fact, 
in  its  practical  application  to  cooking,  has  long  been  re- 
cognized, though  unfortunately  it  is  commonly  disregarded 
in  practice.  In  boiling  meat  it  should  be  plunged,  for  a  few 
minutes  only,  in  boiling  water,  sufficient  just  to  cover  it, 
when  the  superficial  proteids  are  coagulated,  the  joint  is 
"  sealed,"  and  its  salts  and  extractives  retained.  The 
cooking  should  then  be  continued  at  a  much  lower 
temperature.  With  the  exception  of  frying,  it  may  be 
said  generally  that  slow  cooking  is  good  cooking. 

In  roasting,  the  joint  should  be  placed  immediately 
close  to  the  fire  for  a  few  minutes  until  it  is  "  sealed,"  and 
then  moved  back,  the  drying  of  the  continued  roasting 
being  prevented  by  persistent  basting.  In  frying,  the 
meat  should  be  plunged  suddenly  into  a  deep  pan  of  nearl\^ 
boihng  fat  (or  pure  olive  oil).  The  intense  heat  produces 
instantaneous  coagulation  of  the  proteids  on  the  surface. 
So  soon  as  the  "  sputtering  "  has  ceased — in  two  or  three 
minutes — the  cooking  is  completed. 

In  the  cooking  of  vegetables  the  moist  heat  swells  up 
the  starch  grains  and  ruptures  their  envelopes,  so  that  the 
starch  grains  form  a  paste  or  starch  jelly.  Unfortunately, 
though  cooking  increases  the  digestibihty  of  green  vegetables, 
it  still  further  reduces  their  already  low  nutritive  value. 
Their  chief  value  hes  in  their  bulk  and  in  their  mineral  salts. 

The  fats  are  less  affected  by  heat  than  the  proteids  and 


238  NATURAL     THERAPY 

carbohydrates.  By  high  temperature  some  of  the  fat  may 
undergo  partial  decomposition,  by  which  free  fatty  acid 
is  hberated.  It  is  suggested  that  the  greater  digestibihty 
of  cold  fat  over  hot  is  accounted  for  by  the  fatty  acid 
reuniting  with  glycerin  to  form  neutral  fat  on  cooling. 

TEA     AND     COFFEE. 

These  resemble  one  another  in  that  they  both  owe  their 
dietetic  value  and  stimulating  properties  to  the  presence  of 
alkaloids  identical  in  character,  viz.,  theine  and  caffeine.  Tea 
is  used  in  this  country  to  such  a  vastly  greater  extent  than 
coffee  that  a  few  words  may  be  devoted  to  the  consideration 
of  it  from  the  dietetic  point  of  view. 

Formerly  most  of  our  tea  came  from  the  Celestial  Empire, 
but  in  the  latter  part  of  the  last  century  Indian  and  Ceylon 
teas  became  so  popular  as  largely  to  displace  China  tea  in 
the  public  favour.  During  the  past  few  years  a  change  has 
occurred,  and  China  tea  is  steadily  gaining  favour  again. 
On  physiological  grounds  this  is  a  desideratum.  Both 
Indian  and  Ceylon  teas  yield  much  more  of  the  deleterious 
tannin  in  their  infusion  than  good  China  tea.  Further, 
the  longer  Indian  tea  is  infused  the  more  tannin  is  yielded. 
When  infused  for  ten  minutes  Indian  tea  yields  nearly 
twice  as  much  tannin  as  China  tea,  and  thus  tea  from  India 
and  Ceylon  is  much  more  prone  to  cause  gastric  disturbance 
and  discomfort  in  sensitive  persons  than  China  tea. 

The  greatest  ignorance  prevails  on  this  subject,  and  there 
are  a  very  large  number  of  people  who  have  given  up  tea 
altogether,  and  who  try  to  satisfy  their  wants  with  cocoa 
or  milk  and  water,  who,  did  they  know  of  its  value,  would 
be  perfectly  able  to  take  and  enjoy  good  China  tea. 

Those  who  have  become  accustomed  to  the  somewhat 
harsh  and  stronger  flavour  of  Indian  tea  are  inclined  to 
complain  that  China  tea  is  flavourless.  This  is  far  from 
the  case.  Good  class  China  tea  has  a  peculiarly  fine  flavour 
all  its  own,  but  the  cheaper  sorts  do  not  make  very  pleasant 
beverages.  The  late  Sir  Andrew  Clark  and  Dr.  Samuel 
Fenwick  were  both  strenuous  advocates  of  good  black 
China  tea. 

There  is  no  doubt  whatever  that  in  this  country  an 
immense  amount  of  ill-health  and  suffering  is  caused  by 


COMPOSITION     OF    FOOD  289 

the  abuse  of  tea,  which,  so  far  as  abstainers  from  alcohol 
are  concerned,  may  be  described  as  the  national  beverage. 
The  harm  done  is,  indeed,  only  second  to  that  caused  by 
alcohol.  Abuse  is  both  qualitative  and  quantitative.  Some 
people  drink  tea  to  excess  habitually,  and  when  they  begin 
to  suffer  from  irritable  nerves,  sleeplessness,  palpitation,  and 
muscular  tremors,  they  wonder  "  Why  ?  "  Among  the 
working  classes  the  cheaper  kinds  of  tea,  consisting  largely 
of  the  mid-rib  of  the  leaf,  are  used,  and  these  contain  a 
proportionately  greater  amount  of  tannin. 

It  is  a  remarkable  fact  that  the  British  hostess  among 
the  upper  middle  classes  will  guilelessly  offer  the  late  caller 
who  confidingly  trusts  in  her  hospitality  a  cup  of  a  beverage 
which  would  temporarily  inhibit  the  peptic  processes  of  an 
ostrich,  and  which  is  wholly  devoid  of  stimulating  and 
refreshing  properties. 

The  meal  so  popular  among  certain  classes  under  the  name 
of  "  high  tea  "  is  neither  dinner  nor  breakfast,  but  is  a 
physiological  atrocity  which  should  be  strenuously  avoided. 
The  digestion  of  freshly-cooked  meats  is  greatly  delayed  by 
the  presence  of  a  strong  infusion  of  tea.  For  persons  with 
indifferent  assimilative  powers,  tea  taken  three  hours  after 
a  meal  is  least  likely  to  interfere  with  digestion  ;  it  is  at 
once  refreshing  and  an  aid  to  that  process,  as  it  helps 
to  empty  the  stomach.  The  five  o'clock  cup  of  tea 
which  has  of  late  years  become  so  popular  is  therefore 
physiologically  sound. 

ALCOHOLIC     BEVERAGES. 

It  would  be  hazardous  in  the  extreme — even  did  space 
permit — to  deal  at  any  length  with  the  vexed  subject  of 
alcohol,  so  much  difference  of  opinion  existing  on  the 
subject,  not  only  among  the  laity,  but  the  profession. 
It  may  be  safely  said  that  a  very  large  proportion 
of  the  medical  profession  are  total  abstainers.  This  is 
largely  due,  doubtless,  to  the  amount  of  suffering  and 
wretchedness  which  they  see  in  the  pursuit  of  their  pro- 
fession, owing  to  the  abuse  of  alcohol  by  some  of  their 
patients. 

The  use  of  alcohol  has  the  sanction  of  all  the  ages 
from  the  time  of  Noah  to  the  present  day.     No  reasonable 


240 


NATURAL     THERAPY 


person  can  deny  that  it  was  given  us  for  our  use.  Whether 
we  shall  use  it  or  not,  and  whether  if  we  use  it  we  are 
likely  to  abuse  it,  each  individual  must  decide  for  himself. 
In  spite  of  all  that  has  been  said  by  the  ultra-total- 
abstinence  fraternity,  there  can  be  no  question  that, 
dietetically  considered,  we  have  in  alcohol  a  valuable 
stimulant. 

Burney  Yeo  well  says  that  it  is  at  once  a  useful  food,  an 
agreeable  stimulant,  and  a  narcotic  poison,  according  to 
the  dose  in  which  it  is  taken  and  the  tissue  reactions  of  the 
individual  to  whom  it  may  be  administered.  Parkes' 
dictum  that  from  one  to  one  and  a  half  ounces  of  absolute 
alcohol  in  the  twenty-four  hours  is  the  maximum  amount 
which  a  healthy  man  should  take,  "  either  in  the  form  of 
wine,  beer,  or  spirits,"  is  regarded  by  the  large  majority  of 
physicians  as  eminently  sound. 

In  small  quantities,  taken  with  food,  alcohol  in  most 
people  improves  the  appetite  and  increases  the  enjoyment 
of  food,  and  secondarily  improves  digestion.  Many  people 
take  their  food  with  greater  relish  and  pleasure  when  accom- 
panied by  a  glass  of  wine,  and  pleasure  aids  digestion.  The 
sweeping  statements  of  temperance  fanatics  as  to  the 
poisonous  properties  of  alcohol  are  to  be  accepted  with  the 
greatest  reserve.  Gluttony  is  scarcely  less  objectionable 
than  alcoholic  intemperance.  Unquestionably  thousands  of 
people  die  annually  as  a  direct  or  indirect  result  of  the  abuse 
of  alcohol,  but  it  is  open  to  honest  doubt  whether  as  many 
individuals  do  not  die  prematurely  from  over-eating  as  from 
over-drinking. 

The  percentage  of  alcohol  contained  in  the  usual 
intoxicating  beverages  is  set  out  in  the  following  table : — 


Rum 

Whisky 

Brandy  (British)     . 
(French)     . 
Gin 

60  to  75 
50    ,,    60 
50    ,,    60 
50    „    55 
48    „    60 

Burgundy     .  . 
Claret 
Moselle 
Rhine  Wines 
Chablis 

8  t 
8    , 
8    , 
7    - 
7    , 

0  14 
,  12 
,  12 
,    16 

,    10 

Port 
Marsala 

15    . 

15    > 

,    18 

,    21 

Champagne  .  . 
Bitter  Ale     .  . 

6    , 
6    , 

.      9 

Sherry 
Madeira 

14    , 
14    , 

,    18 

,    17 

Porter 
Cider 

4    > 
2    , 

,  7 
>      9 

Sauterne 

1 1    , 

,    18 

Beer 

2 

,      4 

Hungarian  Wines   . 

9    . 

.    15 

Ginger  Beer  (brewe 

d)      ^    ', 

.      3 

COMPOSITION     OF    FOOD 


241 


RELATIVE    DIGESTIBILITY    OF    FOODS. 

Foods  are  described  as  easily  digestible,  and  indigestible, 
or  difficult  of  digestion.  These  terms  require  some 
qualification.  It  is  not  sufficient  merely  to  consider  the 
time  taken  to  complete  gastric  digestion  of  any  food  ;  its 
digestibility  in  the  intestine  must  be  taken  into  account, 
and  the  index  of  intestinal  utilization  is  the  amount  of 
residue  excreted  by  the  bowels. 

The  approximate  time  taken  for  the  gastric  digestion  of 
common  articles  of  diet  is  shown  in  the  following  table. 

TIME    TABLE    FOR    GASTRIC    DIGESTION. 


Artides  of  Diet 

Time  required  for 
Digestion. 

Beef,  boiled 

3  hours. 

„    roasted 

3  to  4  hours. 

,,    smoked. 

4     M  5 

Fish,  boiled 

i|-  to  2i-  hours. 

Oysters  (raw) 
Lamb 

2  hours. 
2i-     „ 

Mutton,  boiled 

3 

,,        roasted 

3  to  2>l  hours. 

Milk         . .             

2  hours. 

Sweetbread 

2        „ 

Ham,  boiled 

2  to  3  hours. 

Pork,  roasted 

5  hours. 

Poultry%  boiled  or  roasted 

2|-  to  4  hours. 

Goose,  roasted 

4       „  5      ., 

Tripe 

Veal  (as  prepared  in  the  Britisl 

1  Isles) 

I   hour. 
4-|-  hours. 

Eggs,  raw 

„     fried  or  boiled  hard 

3  to  3^  hours. 

Cheese 

3     M  4 

Apples 
Cabbage 

3     >.  4 
3i  ..  4 

Carrots       .  .           .  .    - 

3     .,  3i-       „ 

Potatoes 

2\  „  3^        „ 

Turnips 
Rice          \ 

3i  M  4 

fl        „2 

Sago         -  if  completely  cooked 

^'  I        „  2 

Tapioca  j 
Wheaten  Bread 

il        „2 

3     >.  4 

An  ordinary  dinner  is  completely  digested,  leaving  the 
stomach  empty,  in  five  to  seven  hours  in  the  normal 
individual. 

16 


242 


CHAPTER     XVI. 

DIET    IN     HEALTH    AND    IN    THE 
INDIVIDUAL. 

npHE  diet  which  we  accustom  ourselves  to  when  in  health 
^  should  not  always  consist  of  the  most  easily  digested 
substances  ;  by  so  doing  we  may  weaken  our  digestive 
system.  While  not  going  out  of  our  way  to  select  articles 
notoriously  difficult  of  digestion,  it  is  certainly  not  necessary 
or  desirable  that  they  should  be  avoided  if  the  palate 
suggests  them.  A  healthy  diet  is  made  up  of  a  mixture 
in  fair  proportion  of  substances  easy  and  difficult  to  digest, 
the  former  preponderating.  Those  foods  which  are  usually 
found  "digestible"  and  "indigestible"  are  indicated  below. 

Digestible. — Soups  (clear)  ;  fish  {except  mackerel, 
salmon,  crab,  lobster,  and  eel)  ;  chicken,  fowl,  pigeon,  game 
(not  "  high  "),  lamb,  mutton  ;  toasted  or  well-boiled  bacon  ; 
tripe,  sweetbread,  cow-heel,  calf's  head  ;  dry  toast,  plain 
rusks,  stale  bread  ;  other  farinaceous  foods  when  in  modera- 
tion, well-cooked  potatoes,  spinach,  green  vegetables 
generally  in  only  small  quantity  ;  celery,  French  beans  ; 
fruit  (without  pips,  core,  or  skin)  in  small  quantity  ;  milk, 
plain,  or  diluted  with  Vichy,  soda,  or  seltzer  water  ;  tea 
(freshly  made  and  not  strong,  and  preferably  China),  coffee 
(not  black),  thin  cocoa. 

Difficult  of  Digestion. — New  bread,  wholemeal  bread 
(usually),  muffins,  crumpets,  buttered  toast,  pastry  and 
sweets  generally  ;  hard,  long-fibred  meats,  veal,  pork,  and 
beef  ;  sauces,  curries  ;  all  fried  or  re-cooked  meats  ;  fat 
or  rich  food  such  as  duck,  goose,  and  eels  ;  green  vegetables 
generally,  save  in  small  quantities  for  those  whom  they  are 
known  to  suit ;  soups  and  broths,  except  in  small  quantity  ; 
foods  generally  which  leave  a  large  residue  or  which  are  in 
their  nature  irritating,  such  as  seeds,  kernels,  rinds,  skins, 
and  stalks  ;    acid  or  unripe  fruits  ;    sour  wines  ;    tea  with 


DIET     IX     HEALTH  243 

meat,    or    otherwise,    unless     of    moderate    strength    and 
freshly  infused. 

In  regard  to  individualit}'  of  stomachs,  a  well-known 
physician  speaks  as  follows  :  ''If  asked  by  a  patient, 
'  What  shall  I  eat,  doctor  ?  '  say,  '  Eat  what  you  like  !  ' 
If  he  says,  "  How  much  ?  '  reply,  "  As  much  as  your  appetite 
demands  !  '  If  he  asks  '  When  ?  '  say,  '  When  you  are 
hungry  !  '  "  Unfortunately,  though  this  may  be  safe  where 
the  normal  instinct  exists,  it  is  very  often  lost  in  dyspepsia 
and  stomach  disease,  and  such  patients  either  eat  too  much 
and  too  often,  or  more  frequently  almost  starve  themselves. 

No  absolutely  definite  rules  can  be  laid  down  as  to  the 
hours  for  eating.  These  will  be  influenced  by  so  many 
different  factors,  such  as  the  wishes  of  the  individual,  the 
size  of  the  meals,  and  the  exigencies  of  business.  The 
more  irregularity  which  the  individual  can  tolerate,  without 
suffering  or  discomfort,  the  higher  his  standard  of  health. 

So  far  as  the  substances  included  in  the  diet  of  any 
individual  are  concerned,  in  spite  of  the  valuable  work  of 
Chittenden  and  other  prominent  dietitians  and  phvsio- 
logists  at  the  present  day,  the  fact  remains  that  the  practical 
physician  has  no  little  difficulty  in  formulating  any 
definition  of  the  normal  diet  for  a  healthy  man  or  woman. 
W^e  cannot  help  realizing  that  among  a  number  of  individuals 
in  perfect  health,  of  approximateh'  the  same  age  and  body- 
weight,  and  performing  a  similar  amount  of  physical 
labour,  the  food  necessary  to  sustain  them  and  keep  up 
physical  vigour  varies  greatly  in  quantit}'  and  character. 
While  the  general  principle  holds  good  that  given  quantities 
of  flesh-food,  breadstufts,  milk,  butter,  sugar,  and  condi- 
ments— representing  the  essential  proportions  of  proteids, 
carbohydrates,  and  hydrocarbons,  etc.,  and  their  caloric 
value — are  necessary  for  the  average  individual,  yet  the 
quantity  of  these  consumed  may  be  in  inverse  proportion 
to  the  size  and  stature  of  the  individual  ;  for  we  often  find 
very  small  and  very  lean  people  consume  much  larger 
amounts  of  food  than  those  of  much  ampler  proportions. 

Moreover,  we  find  one  man  regards  a  beefsteak  as  the 
staff  of  life  and  foundation  of  physical  energy,  and  looks 
with  pitying  contempt  on  the  person  who  relies  mainly  for 
his  sustenance  on  protein-containing  vegetables  and  starchy 


244  NATURAL    THERAPY 

dishes.  Sir  William  Roberts  used  to  say,  "  Our  stomachs 
(meaning  our  digestive  capacity  and  palates)  are  like  our 
faces,"  and  this  very  suggestive  remark  is  only  another 
way  of  saying  one  man's  meat  is  another  man's  poison. 

Physiological  principles  and  facts  only  hold  good  to  a 
certain  degree,  and  it  must  be  admitted  that  the  dietaries 
of  institutions  such  as  prisons,  poorhouses,  and  schools, 
based  on  stereotyped  proportions  of  food-substances,  are 
not  wholly  satisfactory  in  results,  nor  satisfying  to  all  the 
individuals  concerned.  In  prisons,  while  some  convicts 
get  on  fairly  well  as  regards  diet,  a  proportion  are 
invariably  ravenously  hungry.  Again,  in  schools,  some 
children  are  much  happier  and  healthier  when  the  amount 
of  protein  food  is  diminished  and  fats  and  starches 
increased,  and  vice  versa. 

It  is  useless  ever  to  prescribe  a  dietary  without  taking 
into  account  the  factor  of  personal  idiosyncrasy,  and 
Trousseau  recognized  this  fact  many  years  ago. 

One  of  the  most  common  metabolic  idiosyncrasies  is 
intolerance  of  purin-containing  foodstuff,  especially  such 
articles  as  butcher's  meat  and  strong  tea  and  coffee.* 
While  the  majority  of  mankind  are  quite  capable  of  consum- 
ing these  articles  with  enjoyment,  and,  after  abstracting  a 
considerable  amount  of  nourishment  from  them,  eliminating 
the  by-products  of  digestion,  such  as  xanthin,  hypoxanthin, 
adenine,  guanine,  and  uric  acid,  without  taking  any  hurt, 
not    a    few    individuals    suffer    in    no    light    degree    from 


*  Free  and   bound  purins   in  common  articles  of   diet,  according 
to  Dr.  Walker  Hall  : — 

Fish —  Purins. 

Cod  .  -  .         grs.  per  lb.     4-07 

Salmon  -  -  ,,  ,,        8-15 

Meal- 
Mutton        -  -  -  ,,         ,,        6-7S 

Beef       -  -  -  ,,         ,,        7-96-I4-45 

Chicken        -  -  -  ,,         ,,        9-06 

Liver     -  -  -  ,,         ,,      19-26 

Sweetbread  -  -  ,,         ,,      70-43 

Eggs  and  Cheese,  almost  ,,         .,        o 


DIET     IN     HEALTH  245 

consuming  them.  The  writer  remembers  a  valued  domestic 
servant  once  in  his  service,  who  hved  entirely  on  porridge, 
milk,  cheese,  bread  and  jam,  butter,  and  weak  tea  or  milk 
and  water,  and  maintained  a  good  standard  of  health,  and 
in  whom  the  slightest  departure  from  this  restricted  dietary, 
such  as  the  consumption  of  a  small  portion  of  fresh  lish, 
resulted  in  a  migraine  attack  and  much  discomfort  and 
mental  depression. 

Such  cases  are,  indeed,  very  common,  and  though  one 
may  hardly  be  disposed  to  admit  the  soundness  of  all  the 
pronouncements  of  Alexander  Haig,  the  well-known  writer 
on  the  subject  of  uric  acid,  still  there  is,  unquestionably, 
a  large  proportion  of  truth  in  them,  and  many  of  our  aches 
and  pains  and  attacks  of  "  the  blues  "  must  be  due  to  a 
quantitatively  faulty  dietary,  and  the  daily  endeavour  of 
a  certain  type  of  metabolic  activity  to  deal  with  nutritive 
material  which  it  is  quite  incapable  of  handling.  It  is 
perhaps  too  much  to  say  that  every  individual  suffering  in 
this  manner  is  unhealthy  or  physically  abnormal.  Few 
people  are  absolutely  healthy  if  the  highest  standard  and 
conception  of  health  be  taken.  The  pathologists  who  take 
a  somewhat  morbid  view  of  this  question,  often  declare 
no  one  is  in  a  condition  of  perfect  health. 

The  maintenance  of  a  condition  of  health  and  physical 
comfort,  so  far  as  the  results  of  feeding  are  concerned,  will 
depend  in  very  many  instances  on  a  careful  study  of  the 
individual  as  regards  his  digestive  and  metabolic  capacities 


Vegetables — 

Purins. 

WTiite  Bread. 

Rice,          -              grs.  per  lb. 

o 

Cabbage,  Cauliflower,  Lettuce 

o 

Potatoes 

- 

•14 

Asparagus 

- 

1-5 

Peas 

,. 

3-54 

Oatmeal  - 

- 

3-46 

Beans 

- 

4-i6 

Beverages — 

Wines 

grs.  per  pint 

•0 

-Milk 

- 

•0014 

Beer 

.,            ,, 

I -09-1 -27 

China  Tea  (^Methyl  purins)  grs.  per  tea-cup 

•075 

Ceylon  Tea 

,.            .,             .. 

I -2 1 

Coffee 

,.           ,,             ,, 

1-7 

246  NATURAL    THERAPY 

or  powers.  There  are  many  thousands  of  people  in  a  con- 
dition of  misery  and  physical  incapacity,  at  the  present 
time,  from  the  constant  occurrence  of  headaches  and 
biliousness  due  to  auto-intoxication,  who  may  be  entirely 
rehabilitated  and  literally  set  on  their  feet  by  the  careful 
removal  of  purin-containing  bodies  from  their  daily  dietary. 

On  the  other  hand,  there  are  a  very  large  number  of 
people  whose  nutritional  equilibrium  and  mental  and 
physical  activity  can  only  be  maintained  by  a  diet  contain- 
ing a  large  proportion  of  animal  food,  w^ho  fall  into  ill- 
health  on  a  starchy  diet,  and  to  w'hom  milk  puddings  are 
as  great  a  poison  as  black  coffee  and  beef  steaks  are  to  the 
man  intolerant  of  purins.  Such  individuals  often  have 
a  higher  percentage  of  free  HCl  in  the  gastric  juices  than 
the  normal  physiological  man  ;  and  further,  occupation  and 
habits  have  much  to  do  with  the  matter.  Though  the 
physiologist  may  dogmatically  lay  down  to  a  grain  the 
exact  amount  and  proportion  of  food  for  the  normal 
individual — according  to  whether  his  occupation  is  light, 
medium,  or  heav}/  labour — we  are  still  compelled  to  recognize 
the  fact  that  healthy  people  vary  immensely  in  their 
metabolic  activity.  Whatever  may  be  the  caloric  value  of 
the  food  they  consume,  one  must  remember  that  it  is  trans- 
formed in  very  varying  degrees  and  ways  into  kinetic 
energy  by  the  chemical  changes  which  it  undergoes  after 
absorption.  There  is  much  more  rapid  and  complete 
combustion  with  some  individuals  than  with  others.  We 
require  to  recognize  clearly  that  different  qualities  and 
perhaps  quantities  of  fuel  are  necessary  to  keep  the  various 
types  and  temperaments  of  the  human  machine  in  good 
W'Orking  order  ;  and  the  person  whose  metabolism  requires 
more  of  one  element  than  of  another  in  his  daily  dietary 
can  only  be  properly  regarded  as  abnormal  and  diseased 
when  his  chemical  processes  are  rendered  faulty  by  his 
endeavouring  to  exist  on  stereotyped  and  conventional 
lines  to  which  he  is  physiologically  ill-adapted. 

Milner  Fothergill,  for  instance,  emphasized  the  value  of 
sugar,  in  the  form  of  "  toffee,"  for  children,  and  the  love  for 
sweet  things  which  young  people  almost  invariably  evince 
must  be  regarded  as  essentially  normal  and  physiological. 
Their  desire  for  heat-producing  sugar,   it  is  important  to 


DIET     IN     HEALTH  247 

note,  most  frequently  co-exists  with  an  equally  strong 
dislike  of  fat  foods. 

Parents,  and  those  concerned  in  the  upbringing  and 
education  of  children,  should  realize  that  individual  idio- 
syncrasy in  diet  exists  with  children  as  much  as,  if  not  to 
a  greater  extent  than,  with  adults,  and  it  certainly  savours 
of  cruelty,  and  is  at  any  rate  often  very  unwise,  for  reasons 
of  discipline,  to  force  a  child  to  eat  some  article  of  diet  for 
which  it  evinces  a  pronounced  dislike. 

How  difficult  it  often  is  to  settle  on  a  food  or  milk  mixture 
which  absolutely  suits  an  infant  when  the  natural  food 
fails,  any  nurse  of  experience  can  tell ;  and  it  is  often  found 
that  after  ringing  the  changes  on  various  patent  foods, 
one  of  analytically  poor  food-value  does  best,  where  one 
of  ideal  synthetic  composition  has  ignominiously  failed. 
Metabolic  idiosyncrasy  evidently  begins  very  early  in  life. 

As  old  age  creeps  on,  additional  care  in  the  arrangement 
of  diet  is  needed,  and  almost  invariably  the  amount  of 
butcher's  meat  taken  requires  to  be  greatly  reduced.  In 
those  with  arterial  thickening  and  hypertonus,  this  is  of 
special  importance,  and  many  lives  are  shortened  by  the 
tendency  to  "  keep  up  the  strength  "  with  nutrition,  often 
meaning  highly  stimulating,  nitrogenous  food.  Sir  T. 
Lauder  Brunton  cites  the  case  of  an  ancient  millionaire 
whom  he  put  on  a  pauper's  diet,  chiefly  of  toast  and  gruel, 
which  was  all  his  metabolism  was  equal  to.  On  this  he 
lived  comfortably ;  but  possibly  resenting  this  restricted 
diet,  he  changed  his  physician,  and  being  put  on  a  more 
generous  scale  paid  the  penalty  by  an  early  demise. 

The  loss  of  teeth,  from  which  the  majority  of  old  people 
suffer,  is  at  any  rate  suggestive  on  the  part  of  nature,  and 
possibly  the  substitutes  willingly  furnished  by  the 
prosthetic  dental  surgeon  are  not  unmixed  blessings  if  we 
put  aesthetic  considerations  aside. 

In  old  age,  small  meals  are  best,  but  should  consist  of 
light,  protein-free  foods,  with  carefulh'  chosen  green 
vegetables  (the  coarser  kinds  such  as  cabbage  and  turnips 
being  avoided).  Flatulence  is  the  curse  of  old  age.  Pace 
the  total  abstinence  advocates,  a  small  dose  of  well-matured 
spirit  or  good  wine  would  seem  of  value,  and  Fothergill 
well  describes  wine  as  "  the  milk  of  old  age." 


248  NATURAL     THERAPY 

Putting  age  and  occupation  aside,  the  season  of  the  year 
and  the  cHmate  does  and  must  influence  our  appetite  and 
capacity  for  utihzing  food.  Most  people  consume  and 
really  require  a  larger  proportion  of  food  in  winter  than  in 
summer,  and  on  a  keen  frosty  day  an  amount  of  fat  and  oily 
matter  can  be  consumed  which  would  be  offensive  and 
nauseous  in  summer.  The  love  of  the  Laplander  for  whale 
blubber  and  fat  of  all  kinds  is  notorious,  and  with  the  need 
for  hydrocarbons  which  his  cold  environment  have 
occasioned,  he  has  been  endowed  by  Providence  with  the 
peculiar  digestive  activity  for  satisfactorily  utilizing  them. 
There  appears  to  be  no  constant  balance  in  the  human 
species  between  the  amount  of  animal  and  vegetable  food 
necessary  to  sustain  any  individual.  We  recognize  the 
average  individual,  but  we  are  forced  by  clinical  experience 
to  admit  that  there  are  not  a  few  types  and  modifications 
one  way  and  the  other,  or  our  therapeutics  will  be  futile 
in  many  cases.  From  the  type  of  "  the  perfect  man," 
physiologically,  there  are  variants  who  so  long  as  they 
live  on  food  composed  of  elements  proportional  to  their 
needs  must  be  regarded  as  normal  individuals.  The  fact 
that  metabolic  diseases  are  almost  peculiar  to  man,  shows 
how  common  these  variants  from  the  ideal  type  are,  and 
how  frequently  those  with  individual  peculiarities  suffer 
from  attempting  to  accommodate  themselves  to  the  dietary 
and  habits  suitable  to  the  average  man.  The  proportion 
of  animal  versus  vegetable  food  required  by  them  differing 
from  the  average  standard,  their  efforts  to  conform  to  this 
standard  result  in  imperfect  metabolism  of  either  the  protein 
or  carbohydrate  elements,  and  they  fall  into  ill-health. 
The  man  who  tries  to  convince  his  audience  that  a  diet 
of  nuts,  or  one  free  from  fish  and  meat,  is  the  only  way  to 
physiological  salvation,  would  probably  hesitate  to  feed 
a  sheep  on  beef-steak  !  And  yet  the  anomaly  is  no  more 
glaring  than  certain  individuals  attempting  to  maintain 
health  and  bodily  vigour  on  a  strictly  vegetarian  diet. 

On  the  extent  to  which  the  physician  is  able  by  careful 
investigation  on  scientific  lines  to  gauge  the  metabolic 
capabilities  of  individual  patients,  and  properly  guide 
them  as  to  their  dietetic  habits,  will  largely  depend  his 
success  in  treating  many  forms  of  disease,  and  especially 
chronic  disease. 


249 


CHAPTER     XVII. 
DIET     IN     DISEASE. 

TN  disease  the  diet  may  vary  considerably  from  the 
-*-  normal :  it  may  have  to  be  increased  above  the  amount 
ordinarily  required  by  the  body,  or  it  may  have  to  be 
diminished  as  regards  all  its  constituent  elements  ;  or  one 
or  more  of  these,  either  albumin,  fat,  or  starches,  may 
require  to  be  lessened,  or  even  entirely  removed  from 
the  patient's  dietary.  We  require  therefore  to  consider 
reduced  diet,  increase  of  diet,  and  special  diet. 

On  the  integrity  of  the  various  digestive  glands,  and 
their  proper  supply  with  blood,  and  on  the  normal  condition 
of  the  nervous  system,  will  depend  the  digestion  and 
utilization  of  an  amount  of  food  sufficient  to  maintain 
health. 

The  digestive  function  may  be  affected  in  the  following 
different  ways  :  (i)  Functional  or  organic  disease  of  the 
special  digestive  organs  ;  (2)  Any  constitutional  dyscrasia, 
or  toxaemia ;  (3)  By  the  nervous  system  affecting  reflexly 
or  directly  the  mobility,  secretion,  or  blood-supply  of  the 
special  organ. 

Further,  diets  may  have  to  be  modified  owing  to  the 
functional  or  organic  lesions  disordering  metabolism. 
The  digestive  and  assimilative  activity  of  the  cells  in  the 
body  tissues  are  altered,  and  metabolic  activity  lessened  ; 
this  occurs  in  gout,  diabetes,  and  obesity,  and  may  follow 
various  acute  infective  diseases. 

Hutchison,  who  may  be  regarded  as  one  of  the  greatest 
British  dietetic  authorities  at  the  present  day,  lays  down 
the  following  rules  to  be  observed  in  drawing  up  any  plan 
of  dietetic  treatment  : — 

I.  When  prescribing  a  diet  for  a  case  of  local  disease,  care  must 
be  taken  not  to  sacrifice  the  whole  to  the  part.  The  organs 
are    members    one   of    another,    and    the    patient's    general 


250  NATURAL     THERAPY 

nutrition  must  not  be  interfered  with  in  the  interests  of  any 
one  of  them.  To  avoid  digestive  discomfort  this  is  too  often 
done  in  cases  of  dyspepsia,  and  the  general  vitality  of  the 
patient  lowered  by  too  much  abstemiousness. 

2.  No  article  of  food  must  be  forbidden  without  a  good  reason 

for  doing  so.     Arbitrary  restrictions  must  be  avoided. 

3.  In  acute  disease  one  should  recommend  ;    in  chronic  disease 

forbid. 

4.  Before  recommending  any  article,  it  is  necessary  to  ascertain 

both  whether  the  patient  likes  it.  and  whether  it  agrees 
with  him. 

5.  If  any  special  article  of  food  does  not  agree  with  the  patient, 

it  is  better  to  reduce  it  than  altogether  cut  it  off  from  his 
dietary. 

6.  General  changes  of  dietary  should  be  made  gradually. 

The  following  are  directions  for  the  diet  and  general 
regulation  of  life  in  certain  diseases,  but  are  of  course  only 
general,  and  need  careful  modification  for  individual  cases. 

ANEMIA. 

Patients  require  a  full,  generous  diet,  containing 
relatively  much  albumin  ;  soups  (unless  there  be  dyspepsia, 
when  the  quantity  should  be  very  small)  ;  fish  ;  meat  of  all 
kinds  (except  veal  and  pork),  scraped,  pounded  or  minced, 
when  necessary,  and  for  preference  underdone  ;  poultry, 
game,  sweetbread,  calf's  head,  tripe  ;  bacon,  toasted  or 
well  boiled  (never  fried)  ;  eggs  in  any  form  except  hard 
boiled  ;  all  farinaceous  foods,  including  wholemeal  bread  ; 
vegetables  of  all  kinds  ;  all  fruits  ;  milk  (plain  or  peptonized)^ 
koumiss,  whey,  cream  and  butter  ;  red  wine,  beer,  stout, 
or  porter  ;  chalybeate  waters  and  mineral  waters  generally  ; 
tea,  coffee,  cocoa.  Salt  in  abundance.  Fluids  generally 
in  abundance. 

Articles  Forbidden. — Pork,  veal,  highly  spiced  foods, 
all  re-cooked  foods,  vinegar  and  pickles. 

General    Directions  : — 

1.  Abundant  rest,  especially  in  well-ventilated  rooms 
(sunny  if  possible),  in  the  open  air  and  in  the  sunshine. 

2.  Moderate  exercise,  gradually  increased,  but  always 
stopping  short  of  tiring  point.  It  should  be  taken  preferably 
in  several  short  walks  rather  than  one  long  one.  Patients 
suffering  from  an;emia,  and  invalids  generally,  often  bear 
better  the  exercise  taken  after  noon. 


DIET     IN     DISEASE  251 

CARDIAC    DISEASE. 

When  failure  of  compensation  occurs  owing  to  weakness 
and  atrophy  of  the  myocardium,  dietetic  treatment  is 
especially  called  for. 

The  late  G.  W.  Balfour  laid  down  the  following  rules 
for  such  cases  : — 

1.  At  least  five  hours  between  each  meal. 

2.  No  solid  food  between  meals.     Hot  water  to  be  sipped 

about  three  hours  after  each  meal. 

3.  The  most  important  meal  should  be  in  the  middle  of 

the  day. 

4.  The  meals  should  be  as  dry  as  possible,  and  the  bulk 

of  the  fluid  should  never  exceed  five  ounces. 

Animal  food  should  be  taken  in  moderate  amount  :  lean 
meat,  game,  or  poultry.  White  fish  is  permitted.  A  small 
quantity  of  fat,  in  the  form  of  butter,  e.g.,  is  allowed,  but 
no  sugar,  and  farinaceous  articles  of  food  are  all  reduced. 
Fresh  vegetables  and  certain  kinds  of  fruit  may  be  permitted. 

Such  a  diet  is  especially  adapted  for  a  patient  whose  heart 
is  believed  to  be  fatty. 

Where  fair  compensation  has  established  itself,  plainly- 
cooked  wholesome  food  taken  at  regular  intervals,  with 
avoidance  of  excess,  either  solid  or  fluid,  is  indicated. 

Tea  and  tobacco  are  to  be  banned,  and  some  physicians 
think  alcohol  hardly  more  desirable. 

DIABETES. 

The  principle  to  be  kept  in  view  in  ordering  the  food  of  a 
diabetic  patient  is  that  by  an  exclusively  animal  diet  the 
excretion  of  sugar  in  slight  cases  can  be  entirely  suspended, 
and  in  severe  cases  kept  at  a  very  low  figure. 

So  far  as  is  practicable,  therefore,  fats  and  albuminates 
should  form  the  sole  food  of  the  patient.  The  more  severe 
the  nature  of  the  case,  the  more  rigid  the  adherence  to  this 
rule  should  be. 

It  will  be  found  essential,  however,  to  have  some  regard 
to  the  feelings  and  wishes  of  the  patient.  Some  will 
almost  invariably  resent  being  placed  on  a  diet  composed 
exclusively  of  fats  and  meat,  and  apart  from  their  wishes 
such  a  diet  may  be  actually  injurious  to  them  when  used 
exclusively.     Certainly,    present    opinion    is    that    sudden 


252  NATURAL     THERAPY 

withdrawal  of  all  starches  tends  to  bring  about  the  always 
dreaded  condition  of  acetonaemia.  There  is  an  inclination 
just  now  to  allow  the  patient  a  limited  amount  of  bread 
stuff,  toasted  preferably,  and  this  is  well,  for  the  most 
difficult  problem  in  the  dieting  of  diabetics  has  ever  been 
to  find  some  substitute  for  bread  which  is  at  once  palatable, 
easily  prepared,  and  inexpensive.  Probably  the  power  of 
utilizing  sugar  is  not  wholly  lost  in  any  diabetic. 

A  dietary  somewhat  as  follows  may  be  regarded  as  in 
agreement  with  the  views  of  most  physicians  at  the  present 
time  : — 

Ceteris  paribus,  patients  are  allowed  :  All  clear  soups 
and  broths  ;  fish  of  all  kinds  (except  cod's  liver),  including 
shell-fish  (with  plain  melted  butter  only)  ;  meats  of  all 
kinds  ;  eggs  in  all  forms  ;  cream,  butter,  cheese,  gluten, 
bran  and  almond  breads  and  biscuits  ;  greens,  spinach, 
broccoli,  turnip-tops,  watercress,  mushrooms,  mustard 
and  cress,  cucumber,  lettuce,  tomatoes,  celery  (sparingly), 
endive  ;  French  beans,  cauliflower,  and  asparagus  (the 
green  part),  all  in  great  moderation  ;  strawberries,  goose- 
berries, raspberries,  currants,  peaches,  and  nectarines,  in 
very  small  quantity,  and  occasionally  only  ;  oranges  and 
lemons  ;  rmts  of  all  kinds,  except  chestnuts  ;  pickles, 
olives,  vinegar,  oil  jelly  (sweetened,  if  preferred,  with 
"  saxin  "  or  levulose)  ;  whipped  cream,  custards  ;  koumiss, 
milk  in  great  moderation  ;  tea,  coffee,  cocoa  (nibs)  ;  claret, 
hock,  dry  Sauterne,  Chablis,  Burgundy,  brandy  and 
whisky,  soda-water,  Apollinaris,  seltzer,  Contrexeville, 
Vichy,  Vals  or  St.  Galmier  waters  ;  saccharine  or  levulose 
as  a  sweetening  agent.  Any  alcohol  should  be  ordered  in 
great  moderation. 

Articles  Forbidden. — Sugar  and  starch  in  any  form, 
bread  and  biscuits  (unless  in  small  quantity  when  specially 
directed)  ;  rice,  tapioca,  sago,  vermicelli,  arrowroot,  corn- 
flower, oatmeal  ;  potatoes,  peas,  broad  beans,  parsnips, 
beetroot,  carrot,  Spanish  onions  ;  pastry  and  puddings 
of  all  kinds  ;  fruits  of  all  kinds,  fresh  or  preserved,  except 
those  named  (in  moderation  only)  ;  milk  (except  in  small 
quantity),  ale,  stout,  porter,  port,  champagne,  liqueurs,  and 
cider.  No  flour  should  be  used  in  the  frying  of  food  for 
diabetic  patients. 


DIET     IN    DISEASE  25S 

General    Directions  : — 

1.  Regular  daily  exercise  is  extremely  important,  but 
fatigue  should  be  avoided. 

2.  Flannel  clothing  next  the  skin  always,  most  carefully 
guarding  against  "  catching  cold." 

3.  A  calm,  equable,  regular  life,  with  good  hours,  and 
without  worry  or  excitement  or  over-work. 

4.  Regular  action  of  the  skin  should  be  encouraged  by 
tepid  sponging,  followed  by  skin  friction,  by  warm  bathing, 
massage  and  Turkish  baths. 

It  is  usually  the  better  practice  to  gradually  lessen  the 
carboh^'drate  foods  until  the  sugar  has  disappeared,  and 
afterwards  to  tentatively  replace  them,  noting  the  effect  of 
each  addition  as  a  guide. 

GASTRIC     DISEASE    AND    INSUFFICIENCY. 

Formerly  the  diet  for  patients  suffering  from  stomach 
trouble  would  come  under  the  general  heading  of  dyspepsia 
— a  word  which,  until  recently,  was  used  as  a  cloak  for  want 
of  accuracy  in  diagnosis. 

During  the  past  decade  our  knowledge  of  stomach  disease 
has  been  greatly  enriched,  and  the  analysis  of  gastric  contents 
and  use  of  test  meals  have  become  almost  as  common  as 
urinary  analysis. 

Putting  aside  actual  malignant  disease,  we  generally 
recognize  at  the  present  day  the  following  gastric  affections 
which  require  consideration  from  the  dietetic  point  of  view  : 
Gastritis  (acute  and  chronic),  gastric  neurasthenia  and 
myasthenia,  hyperchlorhydria  and  hypersecretion,  gastric 
dilatation  and  gastric  ulcer. 

In  dealing  with  all  forms  of  gastric  disease,  the  problem 
facing  the  physician  is  to  give  sufficient  food  to  allow  for 
the  nutritive  wants  of  the  organism,  and  at  the  same  time 
to  adapt  the  food  given,  both  in  form  and  quantity,  to  the 
digestive  capability  of  the  patient. 

Acute  Gastritis. — At  first,  the  main  indication  is  rest 
for  the  stomach,  and  entire  abstinence  from  food  must  be 
enforced  for  about  twenty-four  hours,  hot  water  being 
taken  in  sips  at  brief  intervals.  This  lessens  the  nausea 
and  washes  out  imdigested  debris  from  the  stomach. 


254  NATURAL     THERAPY 

When  the  more  acute  symptoms  have  subsided,  milk  and 
hme-water  or  soda-water,  chicken  broth,  toast-water,  or 
barley-water  may  be  taken  every  two  hours.  A  gradual 
return  to  normal  diet  is  then  permitted. 

Chronic  Gastritis. — Avoidance  of  all  articles  of  an 
indigestible  nature  (see  list,  pages  241-2),  and  the  taking 
of  three  well-cooked  digestible  meals  and  no  more  in  the 
twenty-four  hours  are  indicated.  There  should  be  no 
"  snacks  "  between  meals.  All  highly-seasoned  food, 
sauces,  and  spices  must  be  studiously  avoided. 

While  the  patient  is  dressing  in  the  morning,  he  should 
sip  a  glass  of  water,  as  hot  as  can  be  taken  with  comfort. 

HYperchlorhYdria. — This  condition  may  be  associated 
with  chlorosis  or  neurasthenia,  and  be  purely  functional  in 
character,  or  it  may  be  a  symptom  of  a  serious  disease, 
hypersecretion,  or  gastro-succorrhcea  continua  chronica. 

In  either  case  the  dietetic  indications  are  much  the  same. 
Such  patients  are  most  comfortable  with,  and  are  best  able 
to  digest,  a  dietary  which  largely  consists  of  proteid  material. 
Starches  make  them  uncomfortable,  and  are  not  digested. 
Swallowed  saliva  can  scarcely  be  expected  to  exert  any 
diastatic  action  when  there  is  -5  per  cent  free  HCl  in  the 
gastric  juice  ;  nor,  when  the  gastric  contents  pass  on  to  the 
duodenum,  can  the  pancreatic  secretion  act  efficiently.  It 
is  argued  by  some  physicians  that  by  giving  much  proteid 
food  we  are  merely  exciting  increased  secretion  of  HCl 
already  excessive,  and  they  plead  for  a  modified  starch  diet. 
This  view  is  not  generally  held,  however,  and  personally, 
having  carefully  noted  the  effect  of  starch  diet  on  cases  of 
this  nature  which  have  come  under  my  notice,  I  have 
invariably  found  the  patients  were  made  worse. 

Proteids  enter  into  chemical  combination  with  the  free 
acid,  and  alleviate  the  pain  from  which  such  patients  almost 
invariably  suffer. 

All  ill-cooked  and  indigestible  forms  of  meat,  salt  beef, 
and  salt  or  smoked  fish  should  be  absolutely  avoided,  but 
well-cooked  boiled  or  roasted  mutton  or  beef,  fresh  fish, 
milk,  or  raw  eggs,  should  form  the  larger  part  of  the  food 
taken.  A  limited  amount  of  altered  starch  food  may  be 
taken,  such  as  Veda  bread,  and  as  improvement  takes  place, 
toast,  rusks,  etc.,  may  be  added. 


DIET     IN     DISEASE  255 

Strong  tea  or  coffee,  spices,  pickles,  and  sauces  are  entirely 
objectionable,  and  indeed  the  patient  will  usually  volun- 
tarily avoid  them,  as  he  knows  too  well  the  discomfort  and 
pain  which  he  invariabl}^  experiences  after  taking  them. 
Milk  and  soda-water  or  whey  may  be  taken  as  a  beverage, 
and  the  meals  should  be  limited  to  three  in  the  day. 

In  Gastric  Myasthenia  and  Dilatation  of  the  Stomach  the 
indications  are  practically  the  same.  Perhaps  the  most 
important  is  the  limitation  of  fluids.  A  wineglassful  may 
be  taken  with  each  meal,  and  between  meals  fl.uid  in 
quantities  of  a  wineglassful  or  less  at  intervals  of  thirty  to 
forty  minutes.  If  it  is  not  possible  to  give  the  patient  a 
sufficient  amount  of  fluid  for  the  needs  of  the  organism  in 
this  way,  water  may  be  administered" per  rectum. 

Meals  must  be  small  in  bulk,  digestible,  and  nutritious  in 
character.  Probably  the  best  arrangement  is  to  give  four 
small  meals  at  intervals  of  four  hours  in  the  day.* 

Gastric  Ulcer. — In  the  hrst  stage,  when  the  ulcer  is  in 
an  active  condition,  complete  rest  in  bed,  with  rectal  alimen- 
tation alone,  is  often  needed. 

x\fter  ten  da^^s  a  diet  of  peptonized  or  plain  milk  may  be 
employed,  and  after  this  has  continued  for  a  couple  of 
weeks,  more  solid  food  is  given.  The  milk  ma}'  be  thickened 
by  the  addition  of  cornflour  or  arrowroot,  thin  gruel  or 
lentil  food  may  be  taken,  and  then  chicken  purees,  creamed 
fish,  and  finally  tender  meats. 

Gastric  Neurasthenia. — It  is  impossible  to  lay  down 
anything  but  the  most  general  principles  in  the  dietary  to 
be  prescribed  for  an  ailment  in  which  the  symptoms  and 
the  personal  factor  differ  so  much.  No  two  cases  of  gastric 
neurasthenia  are  alike.  In  some  there  is  excess  of  hydro- 
chloric acid,  in  others  there  is  a  condition  approaching 
achylia  gastrica.  Further,  the  condition  of  the  gastric 
secretion  varies  much  from  week  to  week,  and  even  from 
day  to  day.  The  general  line  should  be  to  see  that  the 
patient  takes  a  sufficiency  of  good,  wholesome  food,  whether 
he  suffers  discomfort  after  or  not.     Very  often  the  difficulty 

*  In  gastric  dilatation  dependent  on  pyloric  stricture,  simple  or 
malignant,  dietetic  treatment  is  mere  temporizing.  Such  cases  are 
surgical  in  their  nature. 


256  NATURAL    THERAPY 

in  this  class  of  case  is  to  prevent  the  patient  from  leaving 
off  article  after  article  until  he  has  cut  down  his  diet  far 
below  the  limits  of  health,  and  is  actually  perpetuating  his 
disease  by  an  over-restricted  diet. 

CONSTIPATION. 

Constipation  is  often  induced  and  perpetuated  by  a  too 
exclusively  nitrogenous  diet,  which  is  too  easily  digested, 
and  leaves  but  little  residue  as  the  result  of  digestion.  A 
normal  amount  of  indigestible  residue  acts  as  a  stimulus  to 
the  mucous  membrane  of  the  intestine.  Further,  if  the 
supply  of  fluid  to  the  blood  be  limited,  less  fluid  is  likely  to 
be  secreted  by  the  intestinal  glands,  and  the"  intestinal 
mucous  membrane  becomes  drier.  The  freer  the  supply  of 
water  to  the  blood  the  more  fluid  the  intestinal  secretions  are 
likely  to  be. 

Articles  Allowed. — Clear  soups  ;  fish  ;  meat  of  all  kinds, 
except  veal  or  pork  ;  game,  ham,  bacon  ;  bread  (white, 
brown,  or  wholemeal),  choose  the  coarser  breads  with  bran 
or  wholemeal  when  possible.  The  bread  should  be  taken 
in  fairly  large  quantities,  and  the  kinds  varied  from  time 
to  time  ;  it  should  never  be  new  ;  the  crust  also  should  be 
eaten.  Toast,  with  plenty  of  butter  or  dripping,  is  good. 
Gingerbread  often  acts  well.  Nuts  are  usually  contra- 
indicated,  but  in  some  cases  Brazil  nuts  or  dry  walnuts, 
well  masticated,  appear  to  help.  Oatmeal,  crushed  oats 
with  sugar  and  milk,  or  golden  syrup,  or  old-fashioned 
treacle  ;  cabbage,  cauliflower,  sprouts,  French  beans, 
endive,  celery,  spinach,  salads  with  abundant  oil ;  Spanish 
onions ;  apples,  stewed  or  baked ;  figs,  prunes,  dates, 
Normandy  pippins  or  pears,  stewed ;  oranges,  grapes, 
bananas,  strawberries,  gooseberries,  currants,  etc.  ;  jam, 
marmalade,  preserved  fruits  ;  hot  or  cold  water  ;  tea,  always 
freshly-made  and  never  strong  or  taken  with  meat  ;  coffee, 
thin  cocoa  ;  beer  ;  waters,  such  as  Vichy,  Vals,  St.  Galmier, 
Kissingen,  Carlsbad,  Marienbad,  etc. 

Articles  Forbidden, — New  bread  and  pastry  ;  eggs, 
except  in  moderation  and  lightly  cooked  (best  when 
"  scrambled ")  ;  peas,  broad  beans,  new  potatoes,  rice, 
tapioca,   etc.   (unless  with  fruit  or  jam  or  honey)  ;    nuts 


DIET     IN     DISEASE  257 

of  all  kinds ;    milk   (except  in   small  quantities   or   mixed 
with  Vichy  or  similar  water)  ;  sherry. 
General    Directions  : — 

1.  The  patient  must  be  urged  to  take  a  full  quantity  of 
fluid — for  an  adult  at  least  two  and  a  half  to  three  pints 
daily.  Many  women  suffering  from  constipation  will  be 
found  to  take  only  one  to  one  and  a  quarter  pints  daily ; 
their  constipation  often  depends  upon  this  alone,  and  yields 
when  a  sufficient  quantity  of  liquid  is  taken. 

2.  This  fluid  may  well  include  a  tumblerful  of  water, 
cold  or  hot,  immediately  on  getting  out  of  bed  in  the  morning, 
and  a  tumblerful  of  hot  water  at  bedtime.  Where  hot 
water,  with  or  without  a  saline  aperient,  is  ordered  to  be 
taken  in  the  morning,  the  eflect  is  often  enhanced  if  it  be 
slowly  sipped  while  dressing. 

3.  No  meat  to  be  taken  with  tea  ;  fruit  or  jam,  honey 
or  treacle  with  farinaceous  foods  (e.g.,  blancmange  or  rice), 
and  order  every  night  or  early  morning  a  full  quantit}^  of 
such  fruit  as  stewed  figs,  baked  apples,  Normandy  pippins, 
bananas,  etc. 

4.  The  body  should  be  warmly  clothed  to  avoid  the  skin 
getting  chilled,  and  the  feet  kept  warm  and  dry  by  thick 
boots,  with  a  cork  or  asbestos  sock. 

5.  Tepid  or  cold  sponging,  followed  by  sharp  friction 
with  a  rough  towel  and  flesh-glove,  daily,  to  secure  a 
vigorous  action  of  the  skin. 

6.  Abdominal  massage  for  ten  minutes  before  rising, 
every  morning.  This  (which  can  readily  be  done  by  the 
patient),  followed  by  the  cold  or  hot  water  on  rising,  is  often 
sufficient  to  produce  a  speedy  evacuation. 

DIARRHCEA. 

A  general  dietetic  rule  that  applies  to  all  cases  of  diarrhoea 
is  to  avoid  all  foods  that  leave  much  undigested  residue 
behind  which  would  tend  to  irritate  the  surface  of  the 
intestinal  mucous  membrane. 

The  patient  may  be  allowed  :  cold  milk  (boiled  for 
preference),  plain  or  peptonized,  alone  or  with  lime-water 
or  barley-water  ;  koumiss,  whey,  white  wine  whey,  albumin- 
water,  rice-water ;  soups  (without  vegetables)  thickened 
with  arrowroot,  rice,  sago  or  tapioca,  and  with  or  without 

17 


258  NATURAL     THERAPY 

brandy  in  addition  ;  raw  meat,  pounded  meat  ;  sweetbread, 
tripe  ;  calf's-foot  jelly  ;  eggs,  lightly  boiled  or  poached, 
or  beaten  up  with  brandy  ;  plain  biscuits,  rusks  ;  gruels, 
brandy  or  port  wine,  whisky  and  water,  or  whisky  and  a 
natural  mineral  water  such  as  Apollinaris  or  seltzer. 

Articles  Forbidden. — Rich  soups  and  meat  essences  ; 
green  vegetables,  acid  fruits,  nuts,  potatoes  ;  brown  bread, 
wholemeal  bread  ;  all  hard  foods,  or  hard  meats,  or  rich, 
fat  meats,  especially  veal  and  pork  ;  beef  tea,  malt  tea, 
malt   liquors   and   wines. 

General    Directions  : — 

1.  Warmth  and  absolute  rest  in  bed. 

2.  Warm  clothing,  especially  for  the  abdomen. 

3.  The  food  should  be  given  in  small  quantities, 
frequently  ;   it  is  usually  better  given  cold. 

4.  During  convalescence  the  food  should  be  increased 
cautiously, 

GOUT. 

Views  as  to  the  etiology  of  gout  have  of  late  years  under- 
gone a  marked,  almost  revolutionary  change,  and  the  part 
played  by  uric  acid  and  its  salts  is  now  regarded  as  a  com- 
paratively unimportant  one.  While  at  the  present  moment 
there  is  complete  absence  of  unanimity  as  to  the  actual 
cause,  there  is  general  agreement  that  derangements  of 
the  gastro-intestinal  tract  constitute  an  important  factor 
in  the  development  of  acute  and  chronic  gout.  It  is  there- 
fore of  essential  importance  to  secure  a  healthy  condition 
of  the  gastro-intestinal  mucous  membrane,  and  a  gouty 
patient  can  always  diminish  the  frequency  and  severity  of 
his  attacks  by  a  carefully  arranged  diet,  by  insuring  a  daily 
evacuation  of  the  bowels,  and  by  taking  sufficient  active 
exercise. 

No  single  diet  can  be  regarded  as  suitable  for  all 
gouty  patients,  but  as  a  general  principle  in  many  cases 
the  following  articles  are  allowed  :  All  fresh  vegetables 
freely  (with  exceptions  named)  ;  lish  (with  exceptions 
named)  ;  eggs  in  moderation,  lightly  boiled  or  poached  ; 
meats  (those  of  the  lighter  and  whiter  kinds)  in  great 
moderation  ;  rice,  sago,  and  tapioca ;  fresh  ripe  fruits 
(with   exceptions    named)  ;    soups  ;    toast   or  stale  bread  ; 


DIET     IN     DISEASE  259 

potatoes,  salads,  celery,  and  green  vegetables  (with 
exceptions  named)  ;  milk,  skimmed,  diluted  with  Apollinaris, 
Vals,  Vichy,  or  seltzer  water  ;  lime-juice  freely  diluted  ; 
China  tea,  freshly  infused  and  not  strong  ;  coffee,  which 
should  be  taken  only  in  moderation,  and  not  at  night  ; 
cocoa  ;  tobacco  in  moderation. 

In  small  quantities  only. — Bread,  plain  biscuits,  potatoes, 
asparagus,  tomatoes,  haricot  beans,  broad  beans,  peas,  and 
lentils  ;  eggs  ;  whisky  or  brandy  (not  to  exceed  two  ounces 
in  the  twelve  hours),  unsweetened  gin,  claret,  or  hock, 
freely  diluted  ;  butter  and  cheese. 

Articles  Forbidden. — Fats  and  rich  foods,  re-cooked 
foods,  sauces,  rich  gravies  and  made  dishes  ;  the  harder 
or  richer  meats,  beef,  pork,  or  veal  (as  prepared  in  the 
British  Isles)  ;  smoked,  dried,  or  pickled  fish,  pork,  or 
other  meat  ;  pastry,  jellies,  sugar ;  meat  essences  and 
strong  soups  ;  rhubarb,  gooseberries,  currants,  straw- 
berries (except  in  moderation)  ;  oysters,  mullet,  mackerel, 
salmon,  herring,  eel,  lobster,  crab ;  duck,  goose,  hare  ; 
mushrooms,  truffles,  pickles  and  spices  ;  preserved  fruits  ; 
ale,  porter,  stout,  port  (usually),  champagne  (nearly 
always),  Burgundy,  sherry,  Madeira,  and  all  liqueurs. 

General    Directions  : — 

1.  ^Moderation  in  animal  food,  liberality  in  vegetables. 
The  proportion  of  these  must  be  adapted  to  each  case. 

2.  Abundant  fluid,  of  which  plain  hot  water  (for  prefer- 
•ence  slowly  sipped),  night  and  morning,  may  form  an 
important  part. 

3.  Regular  exercise.  K  gouty  patient  should  walk 
daily  not  less  than  from  three  to  four  miles,  unless  there 
be  reason  to  the  contrary  in  the  individual  case.  Gout, 
however,  is  not  uncommon  in  those  who  take  exercise 
freely,  and  the  degree  and  kind  of  exercise  must  be  carefully 
prescribed  in  each  case. 

4.  Warm  baths,  tepid  or  cold  sponging,  skui  friction, 
massage  and  Turkish  batbs. 

5.  Free  action  of  the  skin,  kidneys,  and  bowels,  regular 
hours,  warm  clothing,  and  the  avoidance  of  fatigue  are 
essential. 

6.  Not  less  than  seven  nor  more  than  eight  hours'  sleep. 
The  patient  should  go  to  bed  early  and  get  up  early. 


260  NATURAL     THERAPY 

OBESITY. 

Unless  the  patient  is  habitually  excessive  in  the  amount 
eaten,  or  unless  the  obesity  be  so  marked  in  degree  as  to 
cause  actual  physical  disability  or  disease,  it  is  best  not  to 
prescribe  any  very  restricted  dietetic  treatment.  Some 
individuals,  though  extremely  stout,  enjoy  excellent  health, 
and  a  revolutionary  alteration  in  their  habits  should  not  be 
lightly  undertaken. 

Changes  in  quantity  and  quality  must  be  graduall}^ 
effected.  It  is  unsafe  to  put  any  patient  on  a  very  restricted 
diet  suddenly.  A  weekly  loss  in  weight  of  three  pounds 
should  not  be  exceeded.  Many  diets  have  been  prescribed 
by  many  authorities,  only  differing  in  details.  They  all 
resemble  one  another  in  the  reduced  caloric  value,  the  aim 
being  to  make  up  deficiency  in  this  respect  from  the  fat  of 
the  patient's  tissues. 

Generally  speaking,  something  like  the  following  is 
suitable. 

Articles  Allowed. — Clear  soups  in  small  quantity  only  ; 
broths,  not  thickened  or  containing  such  ingredients  as 
rice  or  barley;  fish,  and  lean  meat  (with  exceptions  named) ; 
eggs  ;  fruit  ;  green  vegetables  ;  stale  bread,  toast,  rusks 
and  biscuits  in  great  moderation,  or  gluten  and  almond 
bread  or  biscuits  ;  butter  ;  water  (hot  or  cold)  ;  milk 
(skimmed),  diluted  with  Vichy,  Vals,  seltzer,  or  other 
natural  water  ;  tea  or  coffee,  with  saccharin  instead  of 
sugar;  natural  mineral  waters;  claret,  hock,  Chablis, 
whisky  or  brandy,  in  moderation. 

Articles  Forbidden. — Thick  soups  ;  eels,  mackerel, 
salmon,  herrings,  sardines,  with  oil  ;  pork,  duck,  goose  ; 
rice,  tapioca,  macaroni,  oatmeal,  sago,  arrowroot  ;  potatoes, 
peas,  broad  beans,  parsnips,  carrots,  beetroot  ;  pastry  and 
sweets  ;  sugar,  starchy  cocoas  ;  cream  and  milk,  except 
in  great  moderation  ;  ale,  porter,  stout,  port,  champagne, 
and  liqueurs. 

General    Directions  : — 

I.  An  active  life,  with  full  occupation,  short  hours  of 
sleep,  and  the  most  vigorous  exercise  compatible  with  the 
physical  condition.  Cycling,  horse  exercise,  and  fencing 
are  especially  valuable  ;  but  the  form  and  amount  of 
exercise  must  be  carefully  adapted  to  each  case. 


DIET     IN    DISEASE  261 

2.  Free  action  of  the  bowels  and  skin,  with  regular 
Turkish  baths. 

3.  The  entire  quantity  of  liquid  taken,  of  all  kinds, 
should   be    moderate. 

[See  also  the  "Salisbury'^  and  ''Banting'''  Systems, 
pp.  265]. 

PHTHISIS. 

In  the  early  Victorian  era  the  tendency  was  to  underfeed 
patients  who  became  consumptive,  for  fear  of  setting  up 
inflammatory  processes.  The  average  life  of  the  individual 
stricken  with  pulmonary  tuberculosis  was  proportionately 
brief.  After  1840  a  change  occurred,  and  a  more  liberal 
diet  was  allowed  until  the  closing  years  of  the  last  century, 
when  the  sanatorium  treatment  of  consumption  began  to 
boom,  and  the  idea  seems  to  have  got  about  that  the  patient 
should  habitually  over-eat.  The  effect  of  this  in  some  cases 
has  been  disastrous,  if  less  so  than  the  starvation  regimen. 

The  production  of  a  gastrectasis  early  in  the  treatment 
of  any  case  of  pulmonary  phthisis  will  naturally  largely 
diminish  the  patient's  chances  of  regaining  his  health. 

In  a  word,  while  a  liberal  diet  is  very  necessary,  reasonable 
moderation  is  not  less  so.  The  object  to  be  aimed  at  is  to 
get  the  patient  to  eat  enough,  but  not  over-eat. 

Further,  the  diet,  as  to  quantity  and  quality,  and  also  as 
to  time,  frequency,  and  method  of  administration,  must 
necessarily  vary  widely  according  to  the  stage  of  the  disease, 
and  the  condition  of  the  appetite  and  of  the  digestion. 

Articles  Allowed. — All  soups,  broths,  meat  essences  and 
juices  ;  eggs,  preferably  raw  ;  fish,  poultry,  game,  meat 
(scraped,  pounded,  or  minced,  when  necessary)  ;  all  vege- 
tables in  moderate  quantities  ;  all  fruits  ;  milk,  koumiss, 
cream,  tea,  coffee,  cocoa,  chocolate  ;  alkaline  mineral 
waters  ;  beer,  wine,  or  spirit,  as  required  for  each  case. 

Articles  Forbidden. — Veal,  pork,  hard  or  salt  meat, 
re-cooked  foods,  and  pickles. 

General  Directions. — The  method  of  feeding  in  phthisis 
is  as  important  as  the  quantity  and  quality  of  the  food. 
All  food  should  be  appetisingly  cooked  and  daintily  served. 
The  greatest  variation  possible,  even  in  the  matter  of 
serving   milk,  should  be  introduced. 


262  NATURAL    THERAPY 

1.  {a)  On  waking,  milk,  hot  or  warm,  gradually  increasing 
in  quantity  till  ten  to  twelve  ounces  are  taken.  It  may 
contain  a  little  sodium  phosphate  to  help  the  bowels,  or 
sodium  bicarbonate  or  sodium  citrate  to  render  it  more 
easy  of  digestion. 

{b)  If  preferred,  there  may  be  given,  as  a  morning 
stimulant,  a  breakfastcupful  of  tea  made  with  milk  instead 
of  water. 

(c)  Breakfast,  one  hour  later,  should  be  substantial,  and 
is  better  taken  in  bed  before  washing  and  dressing. 

(d)  One  hour  and  a  half  after  breakfast  (so  as  not  to  spoil 
the  appetite  for  luncheon),  one  raw  egg,  or  two  if  possible, 
broken  into  a  glass  and  swallowed  whole,  with  pepper  and 
salt,  or  beaten  up  with  a  little  milk  ;  or  raw  meat,  alone  or 
in  sandwich. 

(e)  Mid-day,  a  substantial  meal  with  (when  indicated) 
beer,  red  wine,  or  spirit. 

(/)  One  hour  and  a  half  after  luncheon,  milk  or  raw  eggs, 
or  raw  meat. 

(g)  In  the  afternoon,  tea  made  with  milk,  or  milk,  with 
raw  eggs,  or  raw  meat,  and  abundant  bread  and  butter. 

(h)  At  7  or  7.30,  a  substantial  meal. 

(i)  At  bedtime,  milk,  and  if  possible  a  raw  egg  in  it  or 
with  it. 

2.  Every  hour  possible  should  be  spent  in  airy,  sunny 
rooms,  or  in  the  open  air  and  sunshine. 

3.  All  rooms  should  be  bright,  and  kept  well  ventilated 
night  and  day. 

4.  Clothing  should  be  light  and  loose.  It  should  be 
woollen,  night  and  day,  winter  and  summer.  The  boots 
should  be  thick  and  sound,  and  contain  a  cork  or  other 
sock  to  keep  the  feet  not  only  dry  but  warm.  Chilled  feet 
may  be  as  harmful  as  wet  feet. 

5.  Every  night  the  whole  body  should  be  sponged  with 
warm  water,  or,  where  the  patient  can  bear  it,  with  cold 
water  (rapidly),  followed  by  friction  with  a  rough  towel 
and  a  flesh-glove.  The  regular,  long-continued  attention 
to  the  action  of  the  skin  forms  one  of  the  most  important 
factors  in  the  hygienic  treatment  of  phthisis.  It  should 
be  carried  out  in  a  warm  room,  under  conditions  which 
prevent  chill  ;    it  is  better  done  for,  than  by,  the  patient. 


DIET     IN     DISEASE  2G:? 

When  there  are  night  sweats,  it  may  be  necessary  to 
regularly  precede  the  skin  friction  by  a  soap  and  water 
cleansing. 

6.  Regular  exercise  carefully  adapted  to  each  case, 
regular  hours,  and  the  avoidance  of  fatigue. 

RENAL    DISEASE    AND    ALBUMINURIA. 

No  rigid  system  of  diet  can  be  formulated  for  all  kidney 
diseases,  nor  for  all  stages  of  any  form  of  nephritis.  In 
determining  the  diet  attention  must  be  directed  for  the  most 
part  to  the  actual  condition  of  the  urine,  but  in  addition 
to  that,  other  factors,  such  as  the  patient's  general  nutrition, 
the  presence  of  dropsy,  the  condition  of  the  cardiovascular 
system,  and  the  presence  or  absence  of  ur?emic  symptoms, 
must  be  taken  into  consideration. 

When  dropsy  and  ursemia  are  present  in  a  marked  degree, 
the  ordering  of  the  diet  must  be  based  on  the  principle  of 
reducing  the  work  thrown  upon  the  kidneys  as  far  as 
possible,  and  this  is  especially  the  method  to  be  adopted 
in  acute  renal  disease.  Indeed,  in  acute  nephritis  it  is  often 
advisable  to  withhold  all  food  for  a  few  days ;  in  subacute 
and  commencing  chronic  cases,  to  allow  only  milk  until  the 
albumin  percentage  is  low.  In  chronic  disease  of  the 
granular  or  "  mixed  "  type,  the  indications  are  to  administer 
food  which  is  readily  assimilable,  will  not  tax  the  digestion, 
and  will  furnish  the  smallest  amount  of  nitrogenous  waste 
calling  for  elimination  by  the  damaged  kidneys. 

The  patient  should  have  a  diet  something  as  follows  : 
Soups  thickened  with  arrowroot,  vermicelli,  rice,  or 
barley.  Fish,  fowl,  pigeon,  game,  butter,  cream ;  eggs 
in  moderation  ;  green  vegetables,  celery,  onions,  salads, 
mushrooms,  artichokes,  cauliflower,  turnips  ;  milk  (plain 
or  with  alkaline  water  or  peptonized),  skim-milk,  whe^^ 
koumiss,  milk  diluted  with  rice-water  or  barley  water  ; 
farinaceous  foods  such  as  bread  (stale),  toast,  rice,  tapioca, 
vermicelli,  arrowroot,  sago,  macaroni ;  tea,  cocoa  and  coffee, 
in  moderation ;  soda-water,  seltzer,  A^ichy,  Vals,  Ems, 
Salutaris,  plain  water  (unless  hard)  ;  in  certain  cases  a 
little  old  whisky,  freely  diluted,  or  red  wine  in  small 
quantity  and  freely  diluted  with  water  or  mineral  water. 


264  NATURAL    THERAPY 

Forbidden  Articles. — Sugar,  ices,  pastry  and  sweet  foods 
generally  ;  new  bread,  butcher's  meats,  especially  of  the 
brown  kinds  ;  beef  tea,  meat  essence  and  jellies,  strong 
soups  ;  re-cooked  meats,  stews,  hashes  ;  highly  spiced  food, 
pickles  and  sauces  ;  rich  foods,  such  as  hare,  duck  and 
goose  ;  potatoes,  peas  and  broad  beans,  except  in  great 
moderation ;  cheese ;  every  form  of  alcohol  (with  the 
occasional  exception  of  those  previously  named). 

General    Directions  : — 

1.  A  quiet  life  without  worry  or  excitement. 

2.  A  warm,  dry,  equable  climate. 

3.  Woollen  clothing  next  the  skin,  night  and  day,  all 
the  year  round. 

4.  Hot-air,  vapour,  or  Turkish  baths ;  daily  tepid 
sponging  with  skin  friction.  Avoid  hot  and  cold  baths, 
but  warm  baths  may  be  taken. 

5.  Regular  daily  exercise,  always  stopping  short  of 
fatigue. 

6.  A  free,  regular  action  of  the  skin,  kidneys,  and  bowels 
should  be  maintained. 


265 


CHAPTER     XV  III. 
SPECIAL     DIET     CURES. 

THE     SALISBURY     SYSTEM. 

'X'HIS  system  was  first  introduced  by  Mr.  J.  H.  Salisbury, 
J-  of  New  York,  who  in  1887  published  a  book  entitled, 
"  Brief  Statement  of  the  so-called  Salisbury  Plan  for  the 
Treatment  by  Alimentation  of  various  Diseases  produced 
by  Unhealthy  and  Indiscreet  Feeding."  The  principles 
laid  down  in  the  treatise  have  been  widely  adapted  in  the 
treatment  of  various  morbid  conditions. 

Salisbury's  system  was  intended  to  influence  diseases 
due  to' improper  feeding  (obesity  for  example),  all  sclerotic 
conditions,  and  those  "  associated  with  excessive  develop- 
ments of  either  the  connective  or  fatty  tissues,"  and  various 
forms  of  dyspepsia.  The  essentials  are  the  taking  of  hot 
water,  and  a  diet  consisting  of  about  two-thirds  lean  meat 
and  one-third  vegetables. 

The  water  should  be  taken  as  hot  as  the  patient  can  bear 
it  ;  one  pint  in  bed  in  the  morning  or  on  rising,  one  pint 
one  hour  and  a  half  before  each  meal,  and  half  an  hour 
before  bedtime.  It  should  be  slowly  sipped,  so  that  the 
time  taken  be  5  to  15  minutes,  uncomfortable  distention 
being  thus  avoided.  If  there  be  thirst  between  meals, 
the  patient  may  take  hot  "  clear  "  water,  lemon  water, 
or  "  crust  coffee."  At  meals,  five  to  eight  ounces  of 
clear  tea  or  clear  coffee  is  allowed.  Food  should  be  either 
the  muscle  pulp  of  beef,  broiled,  broiled  beef-steak  free 
from  fat,  roast  beef,  broiled  or  roasted  lamb  or  mutton  ; 
oysters,  raw,  or  broiled  or  roasted  in  the  shell ;  broiled  or 
boiled  fish  ;  chicken,  game,  and  turkey,  broiled  or  roast  ; 
salt,  pepper,  Worcester  sauce  and  chutney  in  moderation  ; 
celery.  All  meats  should  be  fairly  well  cooked,  and  meals 
should  be  taken  regular^,  either  alone  or  in  the  company 
of  others  taking  the  same  diet. 


266  NATURAL     THERAPY 

It  is  claimed  that  under  this  system  adipose  tissue  will 
rapidly  disappear,  the  loss  of  weight  being  at  the  rate  of 
10  lbs.  to  30  lbs.  per  month,  according  to  the  degree  of 
fatness,  the  strictness  of  the  diet,  the  amount  of  exercise, 
and  the  mental  condition  of  the  patient.  If  the  loss  of 
weight  be  too  rapid,  so  that  the  skin  hangs  in  folds,  such 
food  as  bread,  toast,  rice,  cracked  wheat,  and  potatoes  may 
be  added.  The  loss  of  10  lbs.  to  15  lbs.  a  month  is  advocated 
as  the  ideal  rate  of  weight-reduction.  When  the  desired 
weight  and  bulk  have  been  reached,  the  fat-forming  foods 
should  be  taken  in  such  proportion  as  may  suffice  to 
maintain  them,  usually  two  parts  of  meat  to  one  part  of 
vegetable  bulk.  It  is  stated  that  the  relish  for  beef  may 
become  so  great  that  from  one  to  two  pounds  may  be  taken 
at  each  meal. 

The  body  should  be  washed  twice  daily  with  soap  and 
water,  and  afterwards  rubbed  with  equal  parts  of  glycerin 
and  water.  Regular  exercise,  short  of  fatigue,  should  be 
taken  ;  or,  where  this  is  impossible,  the  body  should  be 
well  rubbed  from  head  to  foot  for  from  ten  to  twenty 
minutes  three  times  daily.  Flannel  or  silk  should  be  worn 
next  the  skin,  and  the  body  be  kept  comfortably  warm. 
All  methods  calculated  to  maintain  health  should  be 
observed. 

The  above  diet  will  cause  most  people  to  lose  weight 
quickly.  Before  advising  anyone  to  rigidly  adhere  to  it, 
however,  it  would  be  well  to  exclude  the  existence  of  chronic 
granular  nephritis.  A  dietary  with  so  great  a  proportion 
of  nitrogenous  food  will  tax  severely  any  but  the  healthiest 
kidneys. 

THE     BANTING    SYSTEM. 

In  1863,  Mr.  William  Banting  published  a  letter  on 
"  Corpulence,"  addressed  to  the  public.  It  was  "  respect- 
fully dedicated  to  the  Public  simply  and  entirely  from  an 
earnest  desire  to  confer  a  benefit  "  on  his  fellow-creatures. 
It  was  issued  at  the  price  of  sixpence,  any  profit  yielded 
being  devoted  to  the  Printers'  Pension  Society.  The 
author  spoke  pathetically  of  the  "  parasite  of  obesity," 
and  told  how  he  had  just  emerged  from  a  very  long 
probation  in  this  affliction,  and  how  he  hoped  the  publica- 


SPECIAL     DIET     CURES  267 

tion  of  this  letter  would  lead  to  the  same  comfort  and 
happiness  he  now  felt  under  the  extraordinary  change. 
He  recorded  that  he  was  66  years  of  age,  5  ft.  5  in.  in 
stature,  and  in  1862  weighed  202  lbs.  He  was  of  active 
and  regular  habits,  and  (as  he  believed)  did  not  indulge 
in  anything  to  excess.  There  was  no  hereditary  tendency 
to  corpulence.  He  had  adopted  increased  bodily  exertion, 
and  especially  rowing,  with,  unfortunately,  development  of 
a  prodigious  appetite,  which  he  w^as  in  some  degree  con- 
strained to  indulge.  He  tried  fresh  air  and  bathing  and 
Turkish  baths  (ninety)  ;  and  took  "  gallons  of  physic," 
"  adopted  riding  on  horseback,  the  waters  and  climate  of 
Leamington,  Cheltenham  and  Harrogate,  and  spared  no 
trouble  or  expense  in  consultations  with  the  best  authorities 
in  the  land."  His  last  state,  however,  was  worse  than  his 
first,  for  he  records  that  he  could  not  stoop  to  tie  his  shoe 
and  had  to  go  down  stairs  slowly  backwards.  He  took 
yet  further  advice  from  a  gentleman,  who  left  him  in  a  worse 
plight  than  ever  to  go  for  his  annual  holiday.  "  This," 
said  Mr.  Banting,  "  was  the  greatest  possible  blessing  to 
me."  He  found  another  adviser,  who  dieted  him,  with 
the  result  that  in  about  a  year  he  recorded  that  he  had  not 
felt  better  in  health  for  the  past  twenty-six  years  ;  that  he 
had  suffered  no  inconvenience  ;  that  he  was  reduced 
13  inches  in  bulk  and  50  lbs.  in  weight  ;  that  he  was  cured 
of  umbilical  rupture  ;  that  he  had  sight  and  hearing  sur- 
prising at  his  age,  and  that  his  other  bodily  ailments  had 
become  mere  matters  of  history.  His  personal  appearance 
improved,  he  bore  the  stamp  of  good  health,  ate  and  drank 
and  slept  well,  had  no  indigestion,  left  off  using  boot-hooks, 
and  could  stoop  with  ease  and  freedom.  He  suffered  no 
longer  from  faintness,  and  left  off  his  knee  bandages. 

The  author  of  this  quaint  historical,  clinical  record, 
states  that  his  diet  before  treatment  was  bread  and  milk 
for  breakfast,  or  a  pint  of  tea  with  plenty  of  milk,  sugar, 
and  buttered  toast  ;  meat,  beer,  much  bread,  and  pastry 
for  dinner  ;  the  meal  of  tea  similar  to  that  of  breakfast, 
and  generally  a  fruit  tart  or  bread  and  milk  for  supper. 
The  diet  ordered  for  him  by  his  adviser,  Mr.  Harvey,  of 
Soho  Square  (whom  he  consulted  for  deafness),  who  learned 
it    from    M.   Bernard's    Paris    Lectures    for   Diabetes,    and 


268  NATURAL     THERAPY 

himself  initiated  it  for  obesity,  forms  the  Banting  system 
detailed  below.  The  remedy  might  have  been,  says  Mr. 
Banting,  as  old  as  the  hills,  but  the  application  of  it  was 
of  very  recent  date.  The  forbidden  foods  were  bread, 
butter,  milk,  sugar,  beer,  and  potatoes.  The  author's  own 
view  was  that  "  saccharin  matter  is  the  great  moving 
cause  of  fatty  corpulence." 

Breakfast  (8  to  9  a.m.)  :  Four  or  five  ounces  of  beef, 
mutton,  kidneys,  broiled  fish,  bacon,  or  cold  meat  of  any 
kind  except  pork  ;  a  large  cup  of  tea  (without  milk  or 
sugar),  a  little  biscuit,  or  one  ounce  of  dry  toast. 

Dinner  (i  to  2  p.m.)  :  Five  or  six  ounces  of  any  fish 
except  salmon,  any  meat  except  pork,  any  vegetable  except 
potato,  one  ounce  of  dry  toast,  fruit  out  of  a  pudding, 
any  kind  of  poultry  or  game,  and  two  or  three  glasses  of 
good  claret,  sherry  or  Madeira — champagne,  port  and 
beer  forbidden. 

Tea  (5  to  6  p.m.)  :  Two  or  three  ounces  of  fruit,  a  rusk 
or  two,  and  a  cup  of  tea  without  milk  or  sugar. 

Supper  (9  p.m.)  :  Three  or  four  ounces  of  fish,  similar 
to  dinner,  with  a  glass  or  two  of  claret. 

Nightcap  (when  inclination  directs)  :  A  tumbler  of 
grog  (gin,  whisky  or  brandy,  without  sugar),  or  a  glass 
or  two  of  claret  or  sherry. 

The  Banting  system  is  sound  in  principle,  has  the  advan- 
tage of  simplicity,  and  forms  the  basis  of  most  dietaries  for 
corpulent  people  at  the  present  day.  The  danger  of  an 
almost  exclusively  nitrogenous  diet,  as  above  mentioned, 
must  here  also  be  borne  in  mind. 

THE     DRY     CURE. 

In  Germany,  Schroth  introduced  the  "  Dry  cure,"  and 
established  an  institution  in  which  it  can  be  practised.  It 
has  received  the  notice  of  eminent  physicians.  Amongst 
other  complaints,  it  has  been  applied  to  cases  of  gastric 
dilatation,  to  the  removal  of  chronic  peritoneal  effusions 
and  rheumatic  effusions  into  joints,  and  to  cases  of 
inveterate  syphilis. 

The  "cure"  consists  in  gradually  depriving  the  patient 
of  fluid  to  an  extent  which  is  said  to  be  absolutely  intolerable 
in  many  instances,  causing  intense  suffering  from  thirst,  and 


SPECIAL     DIET     CURES  269 

exciting  in  most  cases  a  considerable  amount  of  fever,  the 
temperature  rising  as  high  as  104°  F.  The  body  is  at  the 
same  time  submitted  to  warm,  moist  packing.  Fatal  cases 
of  scurvy  have  been  induced  by  this  treatment,  and  the 
results  obtained  have  been  by  no  means  brilliant  ;  it  is 
therefore  not  necessary  to  occupy  further  space  by  describ- 
ing it  in  detail. 

There  are,  however,  undoubtedly  many  morbid  affections 
in  which  a  judicious  limitation  of  fluids  is  calculated  to  be 
advantageous,  and  in  which  a  diet  as  dry  as  can  be 
conveniently  tolerated  is  advisable.  This  is  the  case  in 
circulatory  disturbances  with  a  tendency  to  venous  engorge- 
ment and  to  exudation  into  the  serous  cavities  ;  in  cases 
of  chronic  inflammatory  effusion  which  are  slow  to  disappear  ; 
in  gastric  dilatation  ;  in  cases  of  flatulent  dyspepsia 
induced  by  too  free  use  of  tea,  coffee  and  other  beverages  ; 
and  in  certain  cases  of  excessive  corpulence.  In  considering 
the  dietetic  treatment  appropriate  to  the  last  condition, 
we  have  pointed  out  how  and  to  what  extent  the  limitation 
of  fluids  may  be  applied.  It  must,  however,  be  borne  in 
mind  that  in  gouty  cases,  with  a  tendency  to  uratic  deposits,, 
a  deprivation  of  water  is  calculated  to  do  harm. 

THE     MILK     CURE. 

The  "  Milk  cure  "  has  been  systematically  applied  to 
the  relief  of  many  ailments,  such  as  the  following  :  Dropsies 
of  all  kinds,  cardiac,  renal,  and  hepatic  ;  obstinate  intestinal 
neuralgias  ;  incorrigible  dyspepsias  with  grave  disturbances 
of  nutrition  ;  chronic  colitis  ;  hepatic  disorders,  such  as 
hyperasmia,  simple  hypertrophy,  and  fatty  liver  ;  asthma, 
when  the  consequence  of  pulmonary  catarrh  and 
emphysema ;  neurasthenic,  hysterical  and  hypochondriacal 
states  associated  with  serious  disturbances  of  nutrition  ; 
and  especially  in  disorders  of  nutrition  dependent  on 
latent  catarrhs  of  the  stomach  and  intestines  ;  also  in 
obesity. 

Karell,  of  St.  Petersburg,  considers  the  methodical 
application  of  the  "milk  cure  "  produces  its  curative  effects 
by  acting  as  a  '"  regulator  of  nutrition  "  ;  and  he  maintains 
that  it  is  highly  beneficial,  not  only  in  the  cases  already 
enumerated,  but  also   in    rheumatic    and  gouty  affections. 


270  NATURAL     THERAPY 

organic  diseases  of  the  heart,  advanced  renal  degeneration, 
and  especially  in  degeneration  of  the  arteries. 

The  milk  used  should  be  well  skimmed — as  creamless  as 
possible— and  it  should  be  obtained  fresh  twice  daily  from 
country-fed  cows.  At  first  the  doses  should  be  small. 
Weir  Mitchell  prescribes  4  oz.  every  two  hours,  and  as  the 
doses  are  increased,  the  interval  between  them  is  lengthened 
to  three  hours  ;  he  also  allows  a  glass  during  the  night,  to 
which  a  little  lime-water  is  added  to  keep  it  sweet. 

At  the  commencement  3  oz.  to  6  oz.  are  given  three  or 
four  times  a  day,  and  these  doses  are  scrupulously  adhered 
to,  and  no  other  food  is  taken.  The  doses  should  be  taken 
at  equal  intervals,  and  drunk  slowly  in  small  mouthfuls, 
so  that  the  saliva  may  mix  with  it.  Taken  in  this  way,  it 
will  be  readily  digested,  whereas  drunk  ad  libitum  it  would 
cause  indigestion.  In  winter  the  milk  should  be  warmed 
by  standing  the  glass  in  hot  water  ;  in  summer  it  should 
be  taken  of  the  temperature  of  the  apartment.  It  should 
not  be  boiled  except  in  rare  cases  of  diarrhoea. 

If  the  milk  is  well  digested,  as  indicated  by  small  solid 
motions,  the  dose  is  slowly  increased.  The  first  week  is 
the  difficult  one  to  get  over  ;  during  the  second  week  3^ 
pints  a  day  may  be  taken,  at  fixed  intervals,  viz.,  8  a.m., 
12  noon,  4  p.m.,  and  8  p.m.  These  hours  may  be  changed, 
but  the  intervals  must  be  maintained. 

When  there  is  great  objection  on  the  part  of  the  patient 
to  its  use,  with  nausea  or  disgust,  Weir  Mitchell  allows  it 
to  be  flavoured  with  a  little  tea,  coffee,  caramel,  or  salt. 
He  also  advises,  in  certain  cases,  that  the  general  diet 
should  be  displaced  slowly  until  the  exclusive  milk  diet  can 
be  tolerated.  When  it  provokes  acidity,  some  alkali  may 
be  added,  such  as  lime-water  or  Vichy  water  ;  or  it  may  be 
scalded  with  a  quarter  boiling  water  and  a  little  carbonate 
of  soda  and  salt  added  ;  or  a  little  barley  or  rice-water 
may  be  mixed  with  the  milk  to  prevent  firm  clotting.  The 
patients  seldom  complain  of  either  hunger  or  thirst,  but  if 
those  who  are  seriously  ill  attempt  to  take,  instead  of  the 
four  cups  of  skimmed  milk,  four  large  glasses  of  milk  direct 
from  the  cow,  they  will  certainly  not  be  able  to  digest  it, 
and  the  treatment  will  be  discredited.  In  obstinate 
sickness  and  diarrhcjea,  Karell  has  obtained  the  best  results 


SPECIAL     DIET     CURES  271 

from  these  small  doses,  and  he  cites  one  such  case  in  which 
he  gave  only  four  tablespoonfuls  of  skimmed  milk  three 
times  a  day.  No  doubt,  in  a  case  of  this  kind,  the  almost 
absolute  rest  of  tli©  digestive  organs  which  such  treatment 
affords  is  an  important  agent  in  the  cure. 

Constipation  may  be  regarded  as  a  natural  consequence, 
and  a  sign  that  the  milk  is  absorbed.  It  may  be  remedied 
by  a  simple  enema  of  water,  or  by  a  small  dose  of  castor  oil 
or  rhubarb  ;  and  if  obstinate,  a  little  coffee  should  be  mixed 
with  the  morning  milk,  or  some  stewed  prunes  or  a  baked 
apple  may  be  eaten  at  4  p.m. 

Flatulence  is,  as  a  rule,  completely  relieved  by  this  diet  ; 
if,  however,  any  flatulence  or  diarrhoea  should  be  complained 
of,  it  is  owing  either  to  imperfect  skimming  of  the  milk 
or  to  its  being  taken  in  too  large  a  quantity.  Thirst  may 
be  relieved  by  simple  water  or  seltzer  water. 

If  during  the  second  or  third  week  there  should  be  a  great 
desire  for  solid  food,  a  little  stale  bread  with  salt,  or  a  small 
portion  of  salted  herring  is  permitted  ;  and  once  a  day  a 
little  soup  made  with  milk  and  thickened  with  groats. 
After  five  or  six  weeks  some  modification  is  admissible  ; 
milk,  however,  should  still  be  taken  three  times  a  day. 

It  is  almost  unnecessary  to  point  out  the  importance 
of  combining  rest  with  this  treatment  at  the  commencement, 
for  the  patients  lose  weight  at  first  and  feel  weak  on  account 
of  the  small  amount  taken  ;  after  long  use,  however,  they 
increase  in  weight.  For  the  first  week  or  two  it  also  causes 
sleepiness.  The  tongue  becomes  covered  with  a  white, 
thick  fur,  and  the  patients  complain  of  an  unpleasant, 
sweetish  taste  in  the  mouth  on  waking.  The  stools  are 
of  a  yellowish  colour,  and  have  a  peculiar  odour.  There 
is  usually  a  large  flow  of  urine  which  may  exceed  in  quantity 
the  fluid  ingested,  and  so  lead  to  the  removal  of  dropsical 
effusions.  Weir  Mitchell  has  also  observed  that  uric  acid 
disappears  almost  entirely  from  the  urine,  which  assumes 
"  a  singular  greenish  tint,"  and  when  hot  nitric  acid  is 
poured  upon  it,  it  no  longer  gives  the  usual  mahogany  tint 
at  the  plane  of  contact  ;  and  it  would  seem  that  during 
a  diet  of  milk,  "  the  ordinary  pigments  of  the  urine  disappear 
or  are  singularly  modified."  The  substances  which  give 
rise  to  the  ordinary  faecal  odours  also  disappear. 


272  NATURAL     THERAPY 

"  The  changes  here  pointed  out  are  remarkable  indications 
of  the  vast  alterations  in  assimilation  and  in  the  destruction 
of  tissues  which  seem  to  take  place  under  the  influence  of 
this  peculiar  diet." 

The  duration  of  the  cure  is  ordinarily  about  six  weeks. 
At  the  end  of  this  period  the  quantity  of  milk  should  be 
gradually  reduced  and  solid  food  slowly  introduced  in  the 
place  of  the  milk  meals,  beginning  with  raw  scraped  beef 
and  stale  bread.  But  for  several  months  the  diet  should 
consist  largely  of  milk. 

THE    WHEY    CURE. 

In  many  of  the  German  and  Swiss  spas,  and  especially 
in  those  with  alkaline  and  salt  springs,  where  chronic 
catarrh  of  the  respiratory  organs  is  treated,  such  as  Ems, 
Ischl,  Reichenhall,  etc.,  the  so-called  "Whey  cure"  is 
applied.  This  consists  in  drinking  warm  whey,  either 
alone  or  mixed  with  the  mineral  water,  in  definite  quantities 
at  set  times.  Many  physicians  regard  this  practice  as  in 
all  respects  similar  to  the  use  of  skimmed  milk,  and  in  no 
respect  preferable  except  in  persons  who  find  the  casein 
of  milk  indigestible.     About  20  oz.  daily  are  taken. 

It  relieves  irritable  laryngeal  coughs,  and  exercises  a 
favourable  influence  over  chronic  laryngeal  and  bronchial 
catarrhs.  It  has  been  found  useful  in  certain  forms  of 
dyspepsia,  intestinal  catarrhs,  and  in  chronic  phthisis.  It 
acts  also  as  a  diuretic,  especially  in  combination  with  the 
saline  mineral  waters,  and  recent  observations  have  shown 
that  "  lactose  "  possesses  distinctly  diuretic  properties. 
It  has  been  recommended  in  the  treatment  of  chronic 
Bright's  disease. 

The  "  whey  cure  "  is  not  an  exclusive  diet  cure,  but  it  is 
usual  strictly  to  limit  the  quantity  of  animal  food  taken, 
and  to  augment  the  amount  of  fruit  and  vegetables  ;  it 
adds,  however,  to  the  diet  a  certain  amount  of  milk-salts 
and  milk-sugar.  There  are  various  methods  of  preparing 
whey.     The  following  is  a  good  one  : — 

Take  half  a  pint  of  fresh  rtiilk  heated  to  6o°-65°  C,  and 
one  and  a  half  teaspoonfuls  of  wine  of  pepsin  or  Fairchild's 
essence  of  pepsin,  and  stir  just  enough  to  mix.  Stand  the 
mixture  in  a  warm  place  until  coagulation  occurs.     Next 


SPECIAL    DIET     CURES 


273 


beat  up  the  curd  until  finely  divided,  and  strain.  Whey 
contains  in  solution  the  sugar  and  salts  of  milk,  and  also 
holds  in  suspension  a  considerable  portion  of  fat  and  casein 
which  passes  through  the  strainer. 

At  the  health-resorts  mentioned,  whey  is  prepared  from 
the  milk  of  the  sheep  and  goat,  as  well  as  from  the  cow's 
milk. 


THE    KOUMISS   CURE. 

Koumiss,  or  the  fermented  milk  of  the  Steppe  mares, 
is  used  as  a  food  and  as  an  intoxicating  beverage  by  all  the 
nomadic  tribes  of  the  south-eastern  Steppe  country  of 
Russia. 

The  treatment  in  the  Steppes  lasts  two  or  three  months, 
and  is  often  renewed  the  following  summer. 

Annaeff's  establishment  for  the  koumiss  cure  stands  in 
a  park  on  a  hill  on  the  banks  of  the  Volga,  three  versts 
distant  from  Samara.  It  is  provided  with  a  library, 
theatre,  and  other  comforts.  The  koumiss  is  prepared  by 
a  Tartar  family  in  the  sight  of  the  patients,  and  with  due 
regard  to  cleanliness.  In  its  manufacture  the  milk-sugar  is 
converted  into  alcohol,  carbonic  acid,  and  lactic  acid.  The 
casein  is  in  a  state  of  fine  subdivision  most  easy  of  digestion. 

Table   of  the   Relative   Composition  of  Several 
Strengths  of  Koumiss  {Stange). 


Koujnss 

— Dltration 

OF    Fermen-t.\tiox. 

Mare's 
Milk. 

6  Hours. 

18  Hours. 

30  Hours. 

4  Days. 

Carbonic  Acid    .  . 

3-S 

6-0 

7-0 

II-O 

Alcohol 

— 

i8-^ 

19-5 

30-0 

30-0 

Lactic  Acid 

— 

3-Q 

;-6 

6-4 

6-4 

Milk-sugar 

^I 

i8-8 

i6-3 

Albumin 

23 

22-5 

22-6 

20-0            i6-o 

Fat 

19 

IS-Q 

20-0 

IQ-O               !()•() 

Salts 

5 

4-5 

4-0 

4-0             4-0 

Ah  analysis  of  koumiss,  made  in  Moscow  after  two  days' 
fermentation,  gave  alcohol,  1-65  per  cent  ;  fats,  2-05  ; 
milk-sugar,  2-20  ;    lactic  acid.  1-15  ;    finelv  divided  casein, 

18 


274  NATURAL    THERAPY 

I -12  ;  salts,  0-28  ;  carbonic  acid,  070.  Dr.  Stange  came 
to  the  conclusion  that  "  favourable  results  can  only  be 
obtained  from  the  koumiss  cure  in  the  Steppes,  since, 
besides  the  employment  of  a  genuine  koumiss,  a  hot  and 
dry  climate  is  absolutely  necessary  "  ;  that  it  is  especially 
beneficial  in  catarrhal  conditions  of  the  respiratory  and 
gastric  mucous  membrane  ;  that  it  is  often  successful  in 
the  first  stage  of  phthisis — in  the  second  stage  it  simply 
improves  the  general  condition,  in  the  third  stage  it  is 
badly  borne  ;  that  it  is  especially  curative  in  cases  of 
defective  nutrition  generally — anaemia,  chlorosis,  malarial 
cachexia,  scrofula,  etc. 

Artificial  koumiss  is  prepared  in  England  by  the  Ayles- 
bury and  other  dairy  companies.  But  it  is  in  the  Steppes 
themselves  that  the  best  koumiss  and  the  best  results  of 
the  koumiss  treatment  are  obtained,  although  the  Moscow 
and  St.  Petersburg  institutions  exist  for  the  application  of 
this  cure,  where  koumiss  prepared  from  Steppe  mares  is 
employed.  A  special  select  breed  of  mares  yield  the  milk 
made  use  of.  The  summer  climate  of  the  Steppes  seems 
to  be  especially  favourable  to  the  treatment  of  pulmonary 
complaints,  but  the  winters  are  extremely  severe.  The 
nomads  appear  to  possess  the  art  of  making  koumiss  in  the 
greatest  perfection  ;  but  its  composition  is  by  no  means 
stable.  It  is  comparatively"  rich  in  sugar,  and  poor  in 
casein  and  fat. 

Large  quantities  of  koumiss  can  be  easily  digested,  and 
it  has  been  observed  to  exert  a  diaphoretic  or  a  diuretic 
action,  according  as  the  external  temperature  is  high  or 
low.     Its  use  is  constantly  attended  by  a  gain  in  weight. 

Many  cases  of  phthisis  are  reported  to  have  been  cured  by 
this  treatment  when  followed  in  the  Steppes  of  Orenberg 
or  Samara,  where  doubtless  the  dry  climate  has  also  a 
curative  influence. 

The  best  koumiss  is  made  from  the  milk  of  light-coloured, 
unbroken  mares,  pasturing  in  the  Steppes,  near  mountain 
ranges,  where  they  can  get  running  water  and  salt-beds. 
They  should  be  able  to  bathe  frequently,  and  they  must 
not  have  either  hay  or  oats. 

Two  kinds  are  prepared,  one  light  and  slightly  fermented, 
the  other  strong  and  highly  fermented. 


SPECIAL     DIET     CURES  275 

The  patients  are  made  to  rise  early  and  take  a  glass  of 
koumiss  every  half-hour,  except  during  the  two  hours 
preceding  dinner  and  supper.  Meat  and  fats  form  the 
chief  part  of  the  ordinary  food  ;  sweets,  fruits,  and  salads 
are  avoided,  as  well  as  ices,  coffee,  and  spirits. 

Lime-water  is  used  to  arrest  the  diarrhoea  koumiss  often 
causes.  At  first  a  few  glasses  only  are  taken  daily,  so  as 
to  gradually  accustom  the  patient  to  the  cure. 

Most  invalids  digest  it  well  ;  it  relieves  constipation 
and  acts  as  a  diuretic.  They  gain  in  weight  and  show 
signs  of  increased  blood-formation.  Much  exercise  in  the 
open  air  is  no  doubt  an  important  adjunct  to  the  cure. 

Good  koumiss  is  a  milky  looking,  frothy  liquid,  with  an 
agreeable,  slightly  acid  taste.  It  contains  about  i  per  cent 
of  alcohol  and  lactic  acid.  Its  ready  digestibility  has  been 
referred  to  the  alcohol  in  it  stimulating  the  digestive 
secretions,  and  the  carbonic  acid  allaying  gastric  irritability. 

The  proportion  of  alcohol  in  koumiss  is  too  small  to 
produce  any  symptoms  of  intoxication  ;  but  a  tendency 
to  sleep  and  to  mental  and  bodily  languor  has  been  noticed 
to  follow  its  use.  Excitement  of  the  sexual  organs  has 
also  been  noted  by  several  observers  to  follow  the  use  of 
koumiss. 

THE    GRAPE    CURE. 

The  "  Grape  cure  "  is  another  dietetic  cure  of  which  a  brief 
account  must  here  be  given.  The  nutritive  value  of  grapes 
is  not  great ;  they  contain,  however,  much  sugar  as  well 
as  potash  salts.  They  are  an  agreeable  form  of  food,  and 
afford  one  of  the  few  means  at  our  disposal  between  nutritive 
substances  on  the  one  hand  and  medicinal  substances  on 
the  other.  Much  of  the  benefit  referred  to  this  cure  may 
doubtless  be  attributed  to  the  climatic  advantages 
presented  by  those  agreeable  localities,  such  as  Meran  and 
Montreux,  where  it  is  usually  followed. 

The  effect  of  the  cure  is  aided  by  a  good  supporting  diet. 
Pulmonary  patients  should  not  take  more  than  an  average 
of  2  lb.  daily,  beginning  with  about  a  pound  ;  and  other 
patients  should  not  exceed  4  lb.  In  cases  of  gastric  catarrh, 
3  lb.  a  day  may  be  eaten,  the  diet  at  the  same  time  being 
carefully  regulated.     Constipation,  with  hepatic  congestion 


276  NATURAL    THERAPY 

and  "  abdominal  plethora,"  may  be  benefited  by  3  lb.  to 
4  lb.  daily  ;  and  in  these  cases  the  dose  may,  exceptionally, 
be  increased  to  5  or  6  lb.  The  laxative  influence  of  4  lb. 
to  6  lb.  of  grapes  eaten  daily  has  been  found  beneficial  in 
hsemorrhoidal  affections  and  in  cardiac  diseases  with  a 
tendency  to  visceral  congestion  and  venous  engorgement, 
in  hyperpemia  of  the  liver,  and  in  chronic  constipation. 

The  tendency  of  the  renal  and  hepatic  concretions  is 
often  advantageously  modified  by  this  cure.  It  is  best 
to  begin  with  half  a  pound  of  grapes  in  the  morning  fasting 
(or  an  hour  or  two  after  a  light  breakfast  if  they  disagree 
when  taken  fasting),  and  another  half  a  pound  at  5  p.m. 
After  two  or  three  days  a  third  half-pound  should  be  taken 
between  11  and  12  noon.  Little  by  little  the  dose  is 
increased  to  about  a  pound  each  time.  In  other  cases,, 
which  bear  the  cure  well,  larger  quantities  may  be  prescribed. 
In  some  cases  of  dyspepsia  a  bunch  or  two  at  dessert  may 
be  substituted  for  the  mid-day  dose. 

The  aperient  effect  may  not  be  manifest  at  first,  but  it 
usually  shows  itself  after  a  few  days. 

Figs  and  pears  are  also  permitted  with  the  cure  at  Meran, 
in  order  to  diminish  the  repugnance  to  one  kind  of  fruit 
alone. 

Some  irritation  of  the  gums  is  apt  to  be  excited  during 
the  cure  ;  this  may  be  relieved  by  rinsing  the  mouth  with 
cold  water,  to  which  a  little  bicarbonate  of  soda  is  added. 
It  has  also  been  recommended  that  the  patient  should, 
while  eating  the  grapes,  take  from  time  to  time  a  small 
piece  of  fine  white  bread  to  remove  any  portion  of  the 
fruit  adhering  to  the  teeth. 

Towards  the  end  of  the  cure,  which  lasts  from  four  to 
six  weeks,  the  quantity  of  grapes  should  be  gradually 
diminished. 

The  main  composition  of  grapes,  according  to  Koenig, 
is  :  Water,  78-17  per  cent  ;  sugar,  1436  ;  free  acid,  079  ; 
nitrogenous  extractives,  1-96  ;  stones  and  woody  fibre, 
3-60  ;  total  ash,  0-53.  The  ash  consists  chiefly  of  potash 
salts,  together  with  salts  of  lime  and  magnesia. 
,  The  grape  cure  may  prove  beneficial,  and  is  prescribed 
with  success  in  those  cases  of  "  abdominal  plethora  " 
associated    with    a    deposition    of    much    superfluous    fat  ;, 


SPECIAL    DIET     CURES  277 

much  of  this  fat  may  be  removed  if  the  laxative  influence 
of  the  grapes  is  aided  by  a  spare  diet  in  which  the  fats  and 
carbohydrates  are  strictly  limited.  It  cannot  be  credited 
with  any  real  curative  influence  in  phthisis,  but  it  appears 
to  be  useful  in  cases  of  chronic  bronchial  catarrh  and 
emphysema  ;  and  has  been  found  beneficial  in  cases  of 
gastric  and  intestinal  catarrh  in  anaemic  persons,  in  vesical 
catarrh,  in  gouty  concretions,  and  in  cases  of  malarial 
cachexia. 


278 


Section    M\~Thc    Modem    "  Curer 


CHAPTER    XIX. 


HYDROPATHIC     AND     "CURE" 
ESTABLISHMENTS. 

"DROBABLY  at  no  time  in  the  history  of  mankind  is 
^  "a  cure,"  annnal  or,  at  any  rate,  periodic,  more 
necessary  than  at  the  present  day.  Certainly  at  no  period 
has  the  struggle  for  existence,  the  striving  lor  place  and 
position,  been  so  keen,  or  the  pressure  so  great,  as  in  modern 
life,  more  particularly  modern  city  life.  The  evil  effects 
of  over-feeding  and  over-drinking,  gout  and  plethora,  high 
blood-pressure,  etc.,  are  historic,  and  the  recognition  of  the 
value  of  change  and  the  use  of  mineral  waters  for  these 
conditions  dates  from  very  early  times.  But  during  the 
past  century  a  new  congeries  of  symptoms  or  disorders  has 
sprung  up  with  the  introduction  of  railways,  the  electric 
telegraph  and  the  telephone,  and  that  last  terror,  and  in 
some  ways  shortener  of  the  span  of  hfe,  the  automobile. 

There  is  no  special  name  for  this  disorder,  unless  we  call 
it  acute  neurasthenia  ;  we  usually  say  those  suffering  from 
it  "  need  a  change,"  "  are  below  par,"  or  "  have  been 
overdoing  it."  The  person  concerned  may  be  male  or 
female,  a  votary  of  pleasure,  or  one  who  shuns  amusement, 
whose  mind  is  never  at  rest,  and  who  is  constantly  engaged 
in  the  pursuit  of  wealth.  We  may  think  of  a  man  who  has 
a  large  and  usually  prosperous  business,  with  various 
branches  and  departments,  numerous  clerks,  managers, 
sub-managers,  and  artisans  in  his  employ.  His  "  right- 
hand  man  "  goes  down  with  typhoid  fever,  and  he  is  left 
for  six  weeks  or  two  months  with  practically  two  men's 


MODERN    "CURE"    ESTABLISHMENTS   279 

work  on  his  hands.     During  this  time,  possibly  a  coal  famine 
occurs,  embarrassing  his  business  very  materially,  and  we 
may  further  imagine  that  there  is  money  stringency,  and 
that  in  this  threefold  manner  his  ordinary  normal  daily 
worries  are  multiplied  tenfold.     The  strain  of  the  position  is 
soon  felt  even  by  an  ordinarily  healthy  man,  the  telephone 
bell  becomes  a  continual  jar  on  his  nerves,  the  telegrams 
pouring  in  are  just  so  many  worries  clamouring  at  the  door  ; 
he  becomes  irritable  and  hasty  in  temper,  flies  into  a  passion 
at  a  moment's  notice,  about  what  he  would  usually  con- 
sider a  trifle  ;  noises  ordinarily  unnoticed,  such  as  the  banging 
of  doors  and  whistling  of  trains,  jar  acutely  on  his  nerves  ; 
appetite   fails,    and   finally   sleep   goes   too.     The   appetite 
may  be  flogged  on  by  sherries  and  bitters,  sleep  may  be 
coaxed  by  bromides  and  the  newest  hypnotics,  his  acuteness 
of  care  and  anxiety  may  be  dulled  by  the  free  use  of  alcohol ; 
but,  for  the  time,  a  physical  and  mental  breakdown  has 
occurred  which  no  drug  can  cure,  for  which  "  tonics  "  are 
useless,  and  nothing  but  complete  removal  from  the  field  of 
labours,  with  rest  and  a  thoroughly  wholesome  natural  life, 
can  restore  such  an  individual  to  his  usual  good  health. 
Under  such  conditions,  many  men  go  off  for  a  month's 
golfing  holiday,  and  might  do  much  worse  ;  but  if  thoroughly 
disordered  and  broken  down,  as  such  cases  often  are,  there 
is  little  inclination  for  much  physical  exercise  ;    if  this  be 
taken   to   any  extent,   they  become  unduly  fatigued,  the 
bottle    is    once    more    resorted    to,   and  the  last   state    of 
the  unfortunate  individual  may  be  worse  than   the  first. 
It  is  in  such  circumstances  that  a  health  resort  of  some 
kind,  with  proper  medical  care,  may  be  of  infinite  value, 
and  stay  the  advent  of  general  paralysis  of  the  insane,  or 
some  other  form  of  organic  disease. 

One  may  cite  another  case.  A  woman  passes  through 
a  time  of  great  strain  and  difficulty.  She  may  have  the 
trying  task  of  nursing  a  husband  or  near  relative,  and 
have  gone  through  the  physical  labour  and  vigils  entailed 
with  the  additional  emotional  excitement,  swayed  by  hopes 
and  fears,  and  forgetful  of,  or  at  any  rate  denying  herself, 
what  everyone  requires,  in  the  way  of  fresh  air  and  rest 
when  assaying  this  arduous  task.  Thus,  whatever  the 
event  be  for  the  patient,  the  nurse  grows  pale  and  thin. 


280  NATURAL    THERAPY 

and  looks  weary  and  bloodless.  She  eats  little  and  digests 
less  ;  is  tired  on  the  slightest  exertion  ;  and  becomes 
mentally  depressed  and  emotional. 

Here,  again,  drugs  are  useless.  A  change  of  environment 
and  removal  from  the  scene  of  her  recent  labours  and 
struggles  is  essential,  and  a  month  or  so  spent  in  a 
judiciously  chosen  health-resort,  under  medical  care  and 
advice,  may  save  her  life-long  invalidism.  Many  parallel 
cases  might  be  cited,  but  these  will  suffice. 

Of  "  cures  "  and  health-resorts  the  Continent  offers  great 
wealth  and  variety,  too  many  to  enumerate  ;  the  chief 
difficulty  would  be  the  choice  of  any  particularly  suitable 
one.  Again,  many  of  these  resorts  are  closed  at  certain 
seasons  of  the  year  for  several  months  ;  to  get  to  them  there 
is  often  a  long,  tedious,  and  possibly  expensive  overland 
journey,  for  which  our  invalid  is  quite  unfit,  and  which  will 
only  aggravate  his  condition.  Then,  too,  on  arrival,  he  will 
probably  find  there  is  no  English  physician,  but  possibly 
a  German  or  Swiss  medical  man  speaking  only  fair  to 
indifferent  English,  whom  he  will  find  some  difficulty  in 
getting  to  see  things  from  his  point  of  view,  and  who  will 
be  unable,  in  many  instances,  to  do  what  is  important 
in  the  first  degree — gain  his  complete  and  entire  trust  and 
confidence.  Things  being  so,  the  best  results  cannot  be 
expected. 

Such  an  individual  is  wise  to  give  consideration  to  the 
health  resorts  of  his  own  country.  Bath,  Cheltenham, 
Buxton,  Harrogate,  Matlock,  Strathpeffer,  and  finally  one 
of  the  numerous  excellent  hydropathic  establishments  which 
have  sprung  up  during  the  past  sixty  years,  and  which  offer, 
for  situation,  practically  every  possible  range  of  climate 
which  is  available  in  Great  Britain. 

It  is  to  be  feared  that  among  certain  classes  of  people 
there  is  a  horror  of  anything  which  goes  under  the  name 
hydropathic.  It  is  a  word  which,  from  some  unfortunate 
experience,  they  probably  associate  with  a  Turkish  bath, 
indifferent  cuisine,  shocking  attendance,  and  a  crowd  of 
noisy  and  somewhat  aggressive  visitors,  who  go  on  the 
principle  that  to  reside  under  the  same  roof  for  a  couple 
of  nights  constitutes  an  introduction,  and  gives  them  the 
right  to  address  to  you  anything  from  the  comparatively 


MODERN    "CURE"    ESTABLISHMENTS   28i 

harmless  question  which  sometimes  takes  the  form  of, 
"  How  do  you  hke  the  Hydro  ?  "  to,  "  What  are  you  here 
for  ?  " !  With  these  somewhat  unpleasant  features,  not 
a  few  will  couple  the  fact  that  they  were  totally  unable 
to  obtain  in  the  establishment  any  form  of  alcoholic 
liquor,  which,  if  not  absolutely  forbidden  at  table,  could 
only  be  obtained,  in  dubious  form,  from  a  neighbouring 
chemist  or  grocer.  Then,  again,  those  amusements  !  There 
is  nothing  more  intensely  irritating  to  one  who  is  fatigued 
or  out  of  health  than  to  be  constantly  asked  by  some 
rather  forward  and  persistent  person  who  has  been 
appointed  "  President  of  the  Amusements  Committee,"  to 
join  in  the  egg-and-spoon  race,  the  hat-trimming  competition, 
or  something  equally  frivolous,  if  innocent  and  harmless. 
A  quiet  rubber  is  another  story ;  but  even  to  this  there 
may  be  an  objection,  for  it  is  not  unusual  at  the  present 
day  to  find  people  who  come  away  in  search  of  health, 
having  become  out  of  health  owing  to  too  constant 
an  application  to  "  bridge,"  and  the  late  hours  entailed 
hereby. 

There  are  practically  three  types  of  hydropathic  establish- 
ment :  (i)  The  most  hopeless  and  objectionable  kind,  which 
is  simply  a  poor  kind  of  boarding-house  ;  (2)  The  pure 
pleasure  resort,  which,  however  well  managed,  is .  more 
suitable  for  the  completely  healthy  and  joyous,  than  for 
those  who  are  really  ill ;  (3)  The  best  type  of  hydro, 
which  offers  all  the  advantages  of  a  modern  hotel,  and, 
while  by  no  means  a  hospital,  is  so  managed,  arranged, 
and  constructed  that  the  nervous,  gouty,  rheumatic,  or 
convalescent  person  can  lead  a  pleasant,  wholesome  life 
there,  without  fear  of  noisy  crowds  or  amusements. 

We  may  here  briefly  attempt  to  sketch  the  chief  points 
in  an  ideal  establishment  of  this  nature  :— 

1.  The  building  should  be  of  modern  construction,  and  at 
an  elevation  of  several  hundred  feet  above  the  sea. 

2.  The  situation  should  be  in  the  country',  away  from 
all  town  smoke,  and  preferably  on  an  open  moorland, 
although  the  building  itself  should  be  properly  sheltered 
from  exposure  to  the  north  and  east. 

3.  The  building  should  face  the  south,  and  the  rooms  be 
so  arranged  as  to  have  a  maximum  south  exposure. 


282  NATURAL    THERAPY 

4.  The  rooms  should  be  large,  airy,  and  well  ventilated, 
with  fires  rather  than  steam  radiators  for  heating,  and  be 
lit  by  electricity. 

5.  The  sanitary  arrangements  should  be  of  the  most 
modern  description  and  faultless  in  every  respect. 

6.  The  public  rooms  should  be  large,  airy,  and  sufficient 
to  accommodate  the  maximum  number  of  visitors  comfort- 
ably and  without  unpleasant  crowding. 

7.  The  corridors  should  be  wide  and  well  lighted. 

8.  The  baths  should  be  properly  equipped  with  all  modern 
hydrotherapeutic  arrangements  and  electrical  apparatus. 

9.  The  cuisine  should  be  that  of  a  iirst-class  hotel,  and 
proper  arrangements  should  be  made  for  the  provision  of 
such  special  invalid  diets  as  may  be  required  from  time  to 
time. 

10.  A  qualified  physician  should  be  available  in  the 
establishment,  with  special  experience  in  this  particular 
department  of  medical  work.  The  advantage  to  the  health- 
seeker  of  having  a  reliable  physician  within  call  is  obvious  ; 
whilst  the  assistance  to  the  physician  of  having  patients 
collected  near  his  immediate  observation,  especially  in 
unusually  difficult  and  obscure  cases,  is  very  great.  This  is 
an  advantage  from  which  the  ordinary  medical  attendant 
is  necessarily  debarred.  It  has  been  the  writer's  experience 
on  not  a  few  occasions  to  have  patients  sent  to  be  treated 
by  hydrotherapeutic  measures  for  some  special  conditions, 
and  to  find  after  a  week  or  two  of  careful  observation, 
that  the  cause  of  the  patient's  ill-health  was  something 
widely  different,  and  the  special  conditions  referred  to  by 
the  medical  man  merely  symptoms  of  a  much  more  serious 
disease. 

11.  On  the  essential  need  for  good  management  in  every 
department  it  is  needless  to  dwell,  for  the  same  applies  to 
any  house,  hotel,  or  public  establishment. 

The  Use  of  Drugs  in  "  Cure  "  Establishments. — -As 
patients  placing  themselves  under  the  care  of  a  spa  physician, 
or  coming  to  take  a  "  cure,"  have  often  been  already  treated 
with  almost  every  known  drug  in  any  way  applicable  to 
their  particular  condition,  it  is  plainly  the  reverse  of  common 
sense  to  continue  medication  wliich,  after  careful  trial,  has 
produced  no  benefit.     The  manifest  object  in  coming  to  a 


MODERN    "CURE"    ESTABLLSHxMENTS   283 

"  cure  "  establishment  is  to  try  what  can  be  done  by  natural 
methods.  It  is  well,  therefore,  to  start  fair  and  avoid  con- 
fusion of  issues.  There  must  arise  from  time  to  time  special 
circumstances,  under  which  the  prescription  of  some  drug 
is  desirable  or  even  essential,  and  no  blind  adherence  to  any 
special  form  of  treatment  can  be  expected  to  lead  to  the 
best  results.  An  open  mind  and  eclecticism  in  method  are 
always  best ;  but  patients  who  arrive  with  bundles  of  pre- 
scriptions and  bottles  of  ph3^sic  are  at  the  very  start  best 
advised  to  put  away  the  former  and  throw  away  the 
latter,  commencing  their  treatment  de  novo.  Otherwise 
intellects  are  confused,  and,  if  the  invalids  improve,  it  is 
impossible  to  say  what  is  doing  them  good. 

One  of  the  most  important  factors  in  the  '"  cure  "  at  any 
establishment  is  the  attitude  of  the  patient  himself.  Hope- 
fulness in  regard  to  his  case  is  of  course  essential,  but 
in  addition,  the  invalid  visitor  must  be  freed  fromi  all 
mental  excitement,  and  from  the  cares  and  vexations 
connected  with  his  home  or  business.  So  far  as  is  possible 
he  must  leave  all  these  behind  him,  and  reports  and  letters 
from  managers  or  partners  should  be,  if  possible,  interdicted. 
A  man  who  endeavours  to  combine  his  "  cure  "  with 
negotiations  for  the  purchase  of  a  large  estate  or  a  "  bull  " 
operation  in  copper,  is  wasting  his  time  and  money,  and 
stultifying  himself  and  the  physician  under  whose  charge 
he  has  placed  himself.  The  financial  column  in  the  daily 
paper  should  be  studiously  avoided. 

Indeed,  the  visitor  in  search  of  health  cannot  do  better 
than  lay  to  heart  the  old  Roman  inscription  on  the  baths 
of  Caracalla. 

='="  Curs  vacuus  hunc  adeas  locum 
Ut  morborum  vacuus  abire  queas, 
Hie  enim  non  curatur  qui  curat." 


"  Light  of  heatt  approach  the  shrine  of  health, 
So  shalt  thou  leave  with  body  freed  from  pain  ; 
For  here's  no  cure  for  him  who's  full  of  care." 


284 


CHAPTER    XX. 
FOREIGN     MINERAL     WATERS. 

THE  most  important  element  in  the  curative  properties 
of  any  mineral  water  is,  on  the  authority  of  Burney 
Yeo,  the  water  itself. 

In  certain  mineral  waters,  at  various  Continental 
spas,  however,  there  are  valuable  salts  in  solution,  to  the 
benefit  derived  from  which  many  people  attribute  their 
restoration  to  or  maintenance  of  good  health.  Happily,  at 
the  present  day  it  is  not  necessary  to  travel  afar  to  get  the 
benefit  of  these  trusted  waters,  for,  owing  to  the  enterprise 
of  Messrs.  Ingram  &  Royle,  they  are  now  to  be  had  in 
bottles  all  over  the  kingdom,  and  can  be  taken  as  part  of 
the  cure  at  any  English  health-resort  or  cure  establishment. 
Thus  in  Great  Britain,  without  the  trial  of  crossing  the 
Channel  and  a  long  land  journey,  the  invalid  is  able  to 
combine  dietetic  regimen  and  general  treatment  with  the 
special  water  which  the  physician  decides  is  best  adapted 
to  his  diathesis  and  digestive  capacity. 

THE    SALINE    PURGATIVE    WATERS. 

yEsculap. — This  is  a  saline  aperient  water.  The  spring 
is  situated  in  the  Kelenfold,  Budapest.  It  was  discovered 
by  a  peasant  in  1868,  and  subsequently  purchased  by  a 
company  who  have  taken  every  means  to  prevent  any 
surface  contamination  of  the  spring.  The  bottling  is 
carried  out  under  English  supervision.  The  temperature 
of  the  water  varies  from  6°  to  14°  C. 

iEsculap  salts  contain  90  per  cent  of  purgatives.  The 
active  ingredients  are  magnesium  sulphate,  173  parts, 
sodium  sulphate,  139  parts,  and  calcium  sulphate,  21  parts, 
in  10,000. 

Dose. — As  an  aperient,  lialf  a  tumblerful  before  breakfast. 


FOREIGN    MINERAL     WATERS  285 

Apenta. — A  saline  aperient  spring  also  situated  near 
Budapest.  It  is  rich  in  the  sulphates  of  magnesium  and 
sodium,  containing  3,210  parts  of  MgS04,  and  187  parts  of 
NaS04.  It  is  of  value  in  gouty  conditions,  and  strongly 
purgative. 

Dose. — A  wineglassful  or  more. 

Arabella. — A  water  of  similar  character  and  properties 
to  the  two  former.  It  contains  22  parts  of  magnesium 
sulphate  and  15 "5  parts  of  sodium  sulphate  in  the  litre.  It 
is  useful  in  bilious  and  gouty  conditions. 

Dose. — A  wineglassful  should  be  added  to  half  a  tumbler 
of  boiling  water,  and  sipped  while  dressing  in  the  morning. 

Carlsbad. — The  waters  of  Carlsbad  are  somewhat  milder 
in  character  than  the  foregoing.  The  springs  contain 
varying  proportions  of  sulphate,  carbonate,  and  chloride  of 
sodium.  They  are  therefore  alkaline  in  character,  and 
mildly  purgative.  To  produce  free  purgation  it  is  necessary 
to  supplement  the  ordinary  water  with  some  Sprudel  salt. 

They  help  to  relieve  gastric  and  duodenal  catarrh  with 
accompanying  jaundice,  are  diuretic,  and  undoubtedly 
possess  a  restraining  action  on  the  abnormal  excretion  of 
sugar,  and  are  for  that  reason  much  employed  in  glycosuria 
and  diabetes.  They  are  also  of  service  in  gouty  conditions 
and  obesity. 

Dose. — Several  small  tumblerfuls  should  be  taken  each 
morning  before  breakfast,  fifteen  to  twenty  minutes  being 
allowed  to  elapse  between  each  glass,  and  the  patient 
occupying  himself  in  walking  prescribed  distances  meanwhile. 

The  Carlsbad  Sprudel  salts  may  be  had  in  powder  and  in 
crystals. 

Franz  Josef. — A  saline  aperient  water  from  a  spring  in 
Hungary.  It  is  useful  in  constipation,  hepatic  congestion, 
gastric  and  duodenal  catarrh.  The  active  salts  are  sodium 
and  magnesium  sulphate,  the  former  being  considerably  in 
excess. 

Dose. — From  half  to  one-third  of  a  tumblerful. 

Friedrichshall. — A  saline  aperient  water,  which,  owing 
to  its  richness  in  chlorides,  agrees  with  delicate  stomachs 
somewhat  better  than  other  waters  of  this  class,  and 
is  less  apt  to  be  followed  by  "  reactional  "  constipation. 
It  stimulates  the  flow  of  bile,  which  it  renders  more  fluid 


286  NATURAL     THERAPY 

in  character.     It  is  useful  in  gallstones,  biliary  colic,  duodenal 
catarrh,  and  jaundice. 
Analysis  : — 

In  1,000  parts 

Sulphate  of  Magnesium.  -             -                            -         6-2 

Sulphate  of  Soda              -  -             -             -                5-2 

Chloride  of  Soda        -  -             -             -             -         7-9 

Chloride  of  Magnesium  -  -             -             -               4-9 

Dose. — As  a  strong  purgative,  one  tumblerful.  When 
used  daily,  one  or  two  wineglassfuls  before  breakfast. 

Hunyadi  Janes. — The  spring  is  near  Budapest,  and  the 
water  has  for  upwards  of  twenty-five  years  had  a  great 
reputation  throughout  Europe.  It  has  marked  cholagogue 
properties,  and  so  tends  to  prevent  fermentative  changes  in 
the  intestinal  canal,  and  to  reheve  the  discomfort  due  to 
flatulence. 

The  proportions  of  sulphate  of  soda  and  magnesium  in 
this  water  are  about  equal,  there  being  nearly  4  ounces 
of  each  in  a  gallon  of  the  water.  In  addition  there  are 
119  grains  of  chloride  of  sodium,  47  grains  of  bicarbonate 
of  sodium,  and  a  small  amount  of  free  carbonic  acid. 

Dose. — One-third  to  one-half  a  tumblerful. 

Marienbad. — These  springs  have  recently  been  rendered 
famous  from  the  annual  Royal  patronage.  They  are 
situated  in  Boherriia,  at  an  altitude  of  nearly  2000  feet. 
The  waters  are  chalybeate  as  well  as  alkaline  in  character. 
The  water  from  the  Ferdinandsbrunnen  has  the  following 
composition  : — 

Grs.  per  gallon. 

Sulphate  of  Sodium  _  .  .  -         387-7 

Bicarbonate  of  Sodium  -  -  -  139 

Chloride  of  Sodium  -  -  -  -  1 54 

Bicarbonate  of  Calcium  _  .  .  go 

Bicarbonate  of  Magnesia  -  -  -  -  52 

The  complete  absence  of  sulphate  of  magnesium  is  to  be 
noticed.  The  salts  are  extracted  from  the  waters,  and  are 
to  be  had  in  powder  or  crystal  form,  which  are  convenient 
for  travelling. 

Dose. — A  bottle  may  be  taken  daily,  as  the  water  is  not 
strongly  purgative. 

Pullna. — A  Bohemian  water  situated  at  an  altitude  of 
1200  feet.  It  is  a  bitter  water,  owing  to  the  large  proportion 
of  sodium  sulphate  which  it  contains.     The  temperature  of 


FOREIGN    MINERAL    WATERS  2H7 

the  water  at  the  springs  is  low.  Each  gallon  contains 
approximately  3  ounces  of  sulphate  of  sodium  and  rather 
over  2  ounces  of  magnesium  sulphate. 

Dose. — One  wineglassful  before  breakfast. 

Rubinat. — This  water  is  obtained  from  a  mineral  spring 
situated  in  the  Pyrenees,  and  belongs  to  the  group  of  cold 
sodio-sulphated  waters.  It  has  a  slightly  saline,  not  dis- 
agreeable flavour. 

It  is  a  valuable  water  in  the  treatment  of  constipation 
and  bilious  conditions.  It  is  remarkable  for  the  large 
proportion  of  sodium  sulphate  which  it  contains,  the  Llorach 
spring  having  1,486  gr.  in  each  gallon,  while  the  Serre  spring 
contains  about  1,200  gr. 

The  water  contains  only  a  very  small  proportion  of 
magnesium  salts. 

Dose. — Half  to  one  wineglass  on  rising,  and  the  action  is 
helped  if  it  be  followed  by  a  cup  of  hot  tea  or  plain  water. 

MILDLY     ALKALINE     WATERS,    &c..    &c. 

Contrexeville. — The  springs  are  in  the  Vosges,  in 
France,  situated  at  an  altitude  of  over  3000  feet.  The 
water  is  cool  and  bright,  and  the  presence  of  a  considerable 
amount  of  free  carbonic  acid  gas  renders  it  "  digestible  " — 
that  is  to  say,  not  so  heavy  on  the  stomach  as  a  flat  water. 
Indeed,  it  somewhat  stimulates  appetite  and  digestion  when 
given  before  meals.  The  active  ingredients  are  soda,  potash, 
lithia,  and  magnesium.  It  also  contains  a  small  quantity 
of  iron,  but  it  is  used  almost  entirely  for  its  antacid  and 
antilithic  properties.  It  appears  also  to  possess  the  property 
of  diminishing  the  amount  of  sugar  excreted  in  diabetes  and 
allied  conditions.  It  is  a  water  which  is  very  widely  pre- 
scribed and  used,  apart  from  the  spa  to  which  it  owes  its 
name. 

Dose. — Several  small  tumblerfuls  may  be  taken  before 
breakfast  at  intervals  of  fifteen  minutes. 

Vichy. — This  is  a  water  of  similar  character  from  Allier, 
in  France,  where  are  situated  the  thermal  establishments  of 
the  State  Springs  of  Vichy,  one  of  the  largest  and  best 
equipped  in  the  world. 

There  are  several  springs,  of  which  the  following  are 
most  commonly  used  : — 


288  NATURAL     THERAPY 

The  Celestins  water  is  most  commonly  used  for  bladder 
and  kidney  affections,  also  in  gout,  rheumatism,  and 
diabetes.     The  taste  of  this  water  is  agreeable. 

Grande  Grille. — The  waters  of  this  spring  are  more 
active  in  their  properties.  They  are  used  in  strumous 
conditions,  and  also  for  gallstones  and  hepatic  congestion. 

Hdpital. — The  water  of  this  spring  is  milder  in  character, 
and  is  of  great  value  in  the  digestive  disturbances  of 
delicate  people. 

Dose. — A  bottle  a  day  of  either  of  these  waters  can  be 
safely  prescribed  before  meals,  and  the  greater  part  before 
breakfast  preferably. 

Wildungen. — An  alkaline  water  of  very  similar  character, 
and  useful  in  similar  conditions. 

Dose. — Several  tumblerfuls  may  be  taken  daily. 

Levico. — This  is  an  arsenical  water  obtained  from  a 
spring  situated  near  Trient,  in  the  South  Tyrol.  The  water 
springs  from  four  fissures  in  the  floor  of  a  grotto  known  as 
the  Vitriolo  cavern.  It  contains  25  parts  of  protosulphate 
of  iron,  and  13  grains  of  persulphate  of  iron,  with  •087  parts 
of  arsenious  acid  in  each  10,000  parts  by  weight. 

A  milder  form  of  the  water  is  obtainable  from  the  Ocker 
cavern,  containing  one-tenth  the  amount  of  arsenic  and 
25  per  cent  of  the  iron  in  the  stronger  water. 

Dose. — A  tablespoonful,  gradually  increased. 

La  Bourboule. — This  water  is  also  mildly  arsenical  in 
character.  It  is  obtained  from  springs  of  the  name  at 
Puy  de  Dome,  in  France.  There  is  no  risk  of  overdose  of 
the  arsenic,  for  one  litre  of  the  water  contains  only  28 
mgrams  of  arseniate  of  soda,  and  three-fifths  of  a  pint 
contains  an  average  dose  of  arsenic. 

The  water  is  valuable  in  the  treatment  of  all  forms  of 
cachexia,  chlorosis,  anaemia,  struma,  etc. 

Dose. — Half  to  three  tumblerfuls  may  be  taken  daily  at 
or  after  meals. 

Schwalbach. — This  water  is  chalybeate  in  character,  and 
IS  useful  in  cases  of  anaemia  and  associated  debility. 

There  arc  5  grains  of  protoxide  of  iron  and  i  grain  of 
manganese  in  each  gallon  of  the  Stahlbrunnen  water,  and  a 
considerable  quantity  of  free  carbonic  acid  gas. 

Dose. — Several  tumblerfuls  daily. 


FOREIGN    MINERAL    WATERS         289 

TABLE     WATERS. 

The  following  are  agreeable  dietetic  table  waters  of  mildly 
alkaline  character  : — 

Johannis. — This  spring  is  situated  near  Zollhaus  station, 
Aarthal,  in  the  Province  of  Hesse  Nassau,  in  Germany.  The 
water  issues  from  a  deep  cleft  in  the  rock  at  io°  C. 

St.  Galmier. — Obtained  from  the  springs  in  the  Province 
of  Loire,  France.  This  is  the  most  popular  natural  mineral 
table  water  in  France.  It  is  very  refreshing,  and  suits 
dyspeptics  admirably. 

Apollinaris  is  too  well  knov/n  to  be  more  than  mentioned. 
It  has  acquired  a  great  reputation  among  Americans. 

Perrier  and  Rosbach  are  both  admirable  table  waters. 


19 


290 


BIBLIOGRAPHY. 


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Crescenza. — Ragiomenta     intorno     alia     nuova    Medicinia     dell* 

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BIBLIOGRAPHY  291 

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Lytton,  Sir  E.  B. — Hydropathy,  or  the  Natural  System  of  Treat- 
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Richardson. — Fourteen  Years'  Experience  of  the  Cold  Water 
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Rumford. — Salubrity  of  Warm  Bathing,    1802. 

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Schwertner. — Medicina   Vera   Universalis. 

Shew. — The  Hydropathic  Family  Physician,  1857. 

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Smedley. — Practical  Hydropathy,    1849. 

Smethurst. — Hydrotherapeia,  or  the  Water  Cure,  1843. 

Smith. — Curiosities  of  the  Cold  Water  Cure. 
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Van  der  Heyden. — Arthritifugum  Magnum.     Ghent,  1649. 

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Wainwright. — Enquiry  into  the  Nature  and  Use  of  Baths.      1737. 

Weiss. — Handbook  of  Hydropathy. 

Wilmot. — Tribute  to  the  Water  Cure. 

Wilson. — Principles  and  Practice  of  the  Cold  Water  Cure,  1859. 

Wright. — Memoir  on  Cold  Affusion,  1876,  and  many  Papers  and 
Monographs. 

Winternitz  and  Kisch. — Hydrotherapy  (Solis  Cohen's  System), 
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Massage   and    Physical    Exercises. 

BuMM. — Die  physiologische  wirkung  der  bauch  Massage,  IVien  med. 

Presse,   1892. 
Bogden. — Beitrage  zur  innern  Schleimbauch  Massage,  1804. 
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Dowse,  T.  Stretch. — Lectures  on  ^Massage,  etc.  (Bristol)   1907. 


292         _         NATURAL     THERAPY 

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Physiological  Effects  of  Massage  {Pyactitioner,  Pt.  6,  1887). 
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Graham,  Douglas. — A  Practical  Treatise  on  Massage  (New  York), 
1884.     Recent  Developments  in  Massage  (New  York),  1884. 

Hale,  Creighton. — The  Art  of  Massage,  1902. 

Hood,  Wharton. — The  Treatment  of  Injuries  by  Friction  and 
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KuMPF. — Zur  Technik  und  Wirkungsweise  der  Mecanotherapie  bei 
chronischer  Obstipation  {Wien.  klinisch.  Wochenschr.,  1892). 

Matthieu. — Traitement  des  Dyspepsias  par  le  Massage  {Gazette  des 
Hopitaux,  Paris,  1894). 

Mitchell,  S.  Weir. — Fat  and  Blood  (4th  Edition,  Philadelphia), 
1905. 

Murrell,  Wm. — Massotherapeutics  (London),   1898. 

OsTROM. — -Massage  and  Original  Swedish  Movements,  1906, 

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Reibmeyer,  Alb. — Die  Massage  (Leipsic),  1889. 

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Wide. — Handbook  of  Medical  and  Orthopaedic  Gymnastics,  1903. 

Zabludowski. — Ueber  die  physiologische  bedeutung  der  Massage 
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Albers,  Schoenberg. — Die  Roentgen  Technik.     Pp.  260.     1903. 
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Diseases,  1903. 


294  NATURAL    THERAPY 

Diet. 

Anstie. — The  Use  of  Wines  in  Health  and  Disease.  1876. 

Bauer. — The    Dietary    of   the    Sick     (Von    Ziemssen's    System    of 

Therapeutics). 
Boas. — Diagnostik  und  Therapie  der  Magenskrankheiten. 
Brunton,    T.    Lauder. — The    Physiological    Action    of     Alcohol 

{Practitioner,  1876). 
Davis.  Nathan  S. — Dietotherapy.     Solis  Cohen's  System  of  Thera- 
peutics,  1902. 
Diabetes. — Special  numbers  of  Practitioner.  April.  1905,  and  July, 

1907. 
Duckworth,     Dyce. — Obesity  :      Clifford      AUbutt's     System     of 

Medicine. 
Ebstein. — Der  Fettlebekeit  und  ihre  Behandlung.  1884. 
FoRSTER. — Ernahrung  (Von  Ziemssen's  Handbook). 
FoTHERGiLL,  MiLNER. — Manual  of  Dietetics.  1880. 
Hare,  Francis. — The  Food  Factor  in  Disease. 
Gillespie,    A.    Lockhart. — The    Natural    History    of    Digestion, 

1898. 
Duke,  Clement. — School  Diet. 
Haig,  Alexander. — Diet  and  Food.     Uric  Acid  in  the  Causation 

of  Disease. 
HoFMAN. — Die  bedeutung  der  Fleiscnahrung.  i860. 
Hutchison,  Robert. — Food  and  the  Principles  of  Dietetics,  1901. 
Karell.^ — On  the  Milk  Cure  (Edin.  Med.  Jour.,  1866). 
King,  Chambers. — Manual  of  Diet  in  Health  and  Disease,  1876. 
Leyden. — Handbuch  der  Ernahrungs  Therapie. 
Murray,  David. — Rough  Notes  on  Remedies. 
Newman. — Essays  on  Diet. 
Pkreira,  J. — On  Food  and  Diet. 
Roberts,  Sir  Wm. — Diet  in  Sickness  and  Health.     Digestion  and 

Diet. 
Robertson,  Aitcheson  W. — The  Value  of  Saccharine  Articles  of 

Diet  {Scottish  Med.  Jour.,  1898). 
Thompson,  Sir  Henry. — Food  and  Feeding. 
Thompson,  W.  Gillman. — Practical  Dietetics,  1896. 
Thudichum,  H. — The  Spirit  of  Cookery,  1895. 
VoN  NooRDEN. — Die  Feltsucht,  1900. 

Williams,  W.  Mathieu. — -The  Chemistry  of  Cookery,  1892. 
Yeo,  I.  Burney. — Food  in  Health  and  Disease,  1898. 

Miscellaneous. 

Bannatyne,    Gilbert. — Rheumatoid     Arthritis     (Pathology     and 

Treatment),  1903. 
Brand. — Die  Hydrotherapie  des  Typhus,    1861  (Stettin).     Wasser- 

behandlung  der  typhosen  Fieber,   1877. 
Brunton,    Sir   T.    Lauder. — The  Action  of   Medicines    (London), 

1898. 


BIBLIOGRAPHY  295 

Cybxjlka,    Johann. — Schroth's    Diatetisch    heil    methode     {Archiv 

fur  Physiologische  Heilkunde,   1854). 
EiNHORN.  M. — Diseases  of  the  Stomach,  1901. 

GoLSCHiEDER  AND  Jacob. — Handbuch  der  physikalische  Therapie. 
Hayem     (H.     a.     Hare). — Physical    and      Natural    Therapeutics, 

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the  Treatment  of  Disease  (London),  1906. 
Sandoz.   Fernand. — Introduction  Therapeutique  Naturiste  par  les 

Agents  Physiques  et  Dietetique  (Paris),  1907. 
ScHROTH,  Emanuel. — Johann  Schroth  Grunder  der  Diatkur  unter 

sein  Lebenslauf,  1890. 
Spohr,    R. — Articles     in     Archiv     fiir     physikal.     imd     Diatetische 

Therapie,  190 1-6. 
Van  Valzah  &  Nisbet. — Disease  of  the  Stomach,  1900. 


296 


INDEX. 


ABDOMEN,  Massage  of   .  . 
Abdominal  Bandage,  or 
Neptune's  Girdle 

—  Compress  .  . 

—  Neuroses,      Fango     Mud 

Baths  in 
Abstinence,  Total 
Acid -intoxication.       Electric 

Light  Bath  in 
^sculap  Water 
Aix  Douche     .  . 
Albumin     in     Food,     Caloric 

Value  of 
Albuminuria,  Diet  in 
Alcohol  in  Koumiss  .  . 

—  Percentage    of,    in   Bever- 

ages 

—  its  Use   as   an   Article   of 

Diet 

—  Value  of  in  Old  Age 
Alderman's  Nerve 
Alternating  Current  i68, 
Amenorrhoea,  Sitz  Bath  in  .  . 
Anaemia,  Diet  in 

Animal  Food,  Digestibility  of 
Annaeff's    Establishment    for 

the  Koumiss  Cure 
Anorexia  Nervosa,  Rest  Cure 

in 
Antipyretic    Effect   of   Trunk 

Compress 

—  Value  of  Packs     .  . 
Anus,     Fissure     of.     High- 
frequency  Treatment  of 

Apenta  Water 

Aperient  Waters 

Apollinaris  Water 

Apoplexy,  Risk  of,  and  Pre- 
vention in  Turkish 
Bath       .  .  .  .  34. 

Arabella  Water 

Arenation         .  .  .  .  91 

Arm  Bath 

Arteriosclerosis,  High-fre- 

quency Treatment  of 

—  Nauheim  Treatment  of 
Arthritis,  Fango  Mud  Baths  in 


PAGE 

PAGE 

144 

"D  ACK  Laving 
-D     —  Massage  of 

44 

142 

63 

—  Spouting    .  . 

44 

61 

Balfour,    G.    W.,    on    Diet   in 

Cardiac  Disease 

251 

90 

Banting  System 

266 

239 

Barker  Vibrator          .  . 
Baruch's    Test    for    Reactive 

150 

131 

Capacity 

14 

284 

Basis     of     Hydrotherapeutic 

54 

Applications    .  . 

24 

Bath,  Arm 

35 

230 

—  Foot 

36 

263 

—  Full             

47 

275 

—  Half            

45 

—  Hand 

38 

240 

—  Head           

38 

—  Hot-air  Cabinet    .  . 

IIS 

239 

—  Leg             

39 

247 

—  Plunge 

46 

39 

—  Sand 

91 

192 

—  Schnee  Four-cell  .  . 

209 

43 

—  Sitz              

40 

250 

—  Steam  Cabinet 

117 

233 

—  Sun 

124 

—  Whole  Hydro-electric 

211 

273 

Bathing,  History  of  .  . 

I 

Baths,  Brine   .  . 

92 

152 

—  Chart  of  Temperature  of 

103 

—  Electric-light 

126 

62 

—  Medicated 

92 

68 

—  Nauheim    .  . 

75 

—  Peat,  Fango,  etc. .  . 

84 

227 

—  on  the  Taking  of .  . 

34 

28s 

—  Technique  of 

35 

284 

—  Turkish 

119 

289 

Battery,   Faradic,   Faults  in 

198 

—  Galvanic,  Faults  in 

185 

Battle  Creek  Sanitarium 

4 

,  "9 

Sun  Bath 

124 

285 

Ben  Rhydding,  John  Smedley  and  6 

.  95 

Beverages,  Composition  of  .  . 

233 

35 

Bibliography  .  . 

Blood  Constitution,  Eilect  of 

290 

226 

Hydrotherapy  on 

17 

78 

—  Pressure,   Effect  of  High- 

89 

Currents  on     .  . 

226 

INDEX 


297 


of 


Continuous  Current  .  . 


i6i, 


PAGE 
I  68 


Hydrotherapy   on 

^^ 

Contrexeville  Water .  . 

287 

Bran  Poultices 

71 

Cooking,  Influence  of  on  the 

Brand    (of   Stettin),    and    the 

Digestibility   of   Foods 

236 

Coohng  Bath  in  Typhoid      8 

Cooling  and  Heating,  General 

Bright's  Disease,  Diet  in 

263 

and  Local  Effects  of.  . 

12 

Whey  Cure  in 

272 

Corpulence,  Treatment  of   .  . 

265 

Brine  Baths    .  . 

92 

Coryza,  Value  of  Baths  in     37,  39 

Brunton,  Lauder,  on  Diet  in 

Crank  Collectors 

166 

Old  Age 

247 

Cream,  Caloric  Value  of 

231 

Buttermilk 

235 

Crisis,  the  Nature  of .  . 

5 

Cure,  the  Modern 

278 

/^ALORIC  Value  of  Foods 
W     Carbohydrates,      to     be 

230 

Cures,  Special  Diet     .  . 

265 

Current,  Alternating.  .           168 

192 

Avoided  in  Diabetes.  . 

251 

—  Alternator   and   Combiner 

182 

—  Caloric  Value  of  .  . 

230 

—  Collectors  .  . 

165 

Carbonic  Acid  Gas  Generator 

—  Continuous 

161 

for  Nauheim  Baths    .  . 

76 

—  Faradic 

189 

Cardiac  Disease,  Diet  in 

251 

—  —  Regulation  and  Measure- 

— Dullness    as    Affected    by 

ment  of 

199 

Nauheim  Baths 

78 

—  Galvanic 

161 

Cardio-vascular  System,  Effect 

—  —  Density  of 

184 

of  Hydrotherapy  on .  . 

18 

—  High-frequency     .  . 

218 

Carlsbad  Waters 

285 

—  Induced 

191 

Cells,  Acid 

163 

—  from  Main 

168 

—  Choice  of  .  . 

161 

—  Precautions       Con- 

— Dry             

164 

cerning 

174 

—  Leclanche 

163 

—  Reversers  and  Combiners 

181 

Cereals,  Composition  of 

232 

—  Sinusoidal 

204 

Chapman's  Spinal  Ice  Bag.. 

74 

—  Primary    and     Secondary 

Charcot  and  Hydrotherapy .  . 

8 

Faradic 

194 

Cheese  as  a  Source  of  Proteins 

235 

Currie's  Work  on  the  Water 

Chest  Compress 

60 

Cure 

2 

—  Massage  of 

142 

Cutaneous     .Areas     Reflexly 

Childhood,  Diet  in     .  . 

246 

Associated     with     In- 

Chittenden on  Diet  .  .         229, 

243 

ternal  Parts    .  .        22,2 

3.  25 

Claridge's  "  Cold  Water  Cure  " 

4 

Colitis,  Water  Injections  for 

30 

-^AIRY      Products,     Com- 
i-J     position  of 

Colon,  Irrigation  of  .  . 

29 

231 

Compress,  Chest 

60 

D'Arsonval  Galvanometer    .  . 

178 

—  Electro-thermal    .  . 

63 

De  Watteville  Alternator     .  . 

1S2 

—  Head          

58 

Diabetes,  Diet  in 

251 

—  Throat 

59 

—  Electric-light  Bath  in 

131 

—  Trunk 

61 

—  High-frequency     Currents 

Compresses,  Packs,  Poultices, 

in 

227 

etc..  Technique  of 

56 

—  Hot-air  Bath  in    .  . 

116 

Constipation,  Diet  in 

256 

—  Sun  Bath  in 

126 

—  Grape  Cure  in 

275 

Diarrhoea,  Diet  in     .  . 

257 

—  High-Frequency     Treat- 

Diet in  Cardiac  Disease 

251 

ment  in 

227 

—  —  Childhood 

246 

—  Massage  in 

147 

—  —  Constipation    .  . 

2^6 

—  Milk  Diet  Causing 

271 

—  Cures 

265 

—  Sinusoidal  Current  in 

208 

—  in  Anasmia 

250 

Consumption,  Diet  in 

261 

—  —  Diabetes 

251 

—  High-frequency  Currents  in 

228 

—   —  Diarrhoea 

257 

—  the  Koumiss  Cure  for 

273 

—  —  Disease 

249 

298 


INDEX 


PAGE 

Diet  in  Gastric  Disease 

253 

—  —  Gout     .  . 

258 

—  —  Health     and     in     the 

Individual    .  . 

242 

Obesity             .  .  260,  26=: 

,266 

Old  Age 

247 

Renal  Disease 

263 

Phthisis 

261 

—  —  the  Rest  Cure 

154 

—  —  —  Treatment   of    Dis- 

ease 

229 

Digestibihty  of  Animal  Foods 

233 

—  Influence  of  Cooking  on .  . 

236 

—  of  \'egetable  Foods 

235 

Digestion,  Time  Table  for   .  . 

241 

Douche.     Aix     and     Vichy 

Massage 

54 

—  Filiform 

53 

—  Horizontal 

51 

—  Main  Factors  in   . 

50 

—  Needle 

53 

—  Percussion 

51 

—  Rain 

52 

—  Scotch 

52 

—  \'aginal 

31 

Dowsing  Radiant  Heat 

96 

Baths,    Description 

of           

109 

Drip   Sheet,    Indications   and 

Technique 

48 

Dropsy,  Diet  in 

263 

—  Miik  Cure  in 

269 

Dry  Cure,  Schroth's.. 

268 

Dyspepsia,  Massage  in 

147 

-pFFLEUVE    of    High-fre- 
i--'     quency    Current,  Value 

as  Counter-irritant     .  . 

225 

Electric    Bath,    Short-circuit- 

ing in   .. 

175 

—  Battery,  Failure  to  Work 

198 

—  Currents  from  Main,  Pre- 

cautions  Concerning .  . 

174 

—  Light  Baths,  Varieties  and 

Indications 

126 

—  Massage      .  .          .  .         149, 

202 

—  Sweating  Mattress 

68 

Electricity,      Frictional     or 

Static 

213 

—  High-frequency     .  . 

218 

—  and  Quackery 

159 

—  Sources    of,     for    Medical 

Purposes 

161 

—  in     the     Treatment     of 

Disease 

158 

Electrodes  for  P'aradi 

sm 

202 

PAGE 

Electrodes  for  Galvanism    . .  182 

—  —  High-frequency  Currents  223 

—  —  Static  Electricity  ..  215 
Electro-thermal  Compress  .  .  63 
Enuresis,  Psychrophore  in  .  .  33 
Epistaxis,      Foot     or     Hand 

Baths  in  .  .  ^7,   38 

Ergos  Static  Machine            .  .  213 

FANGO  Mud  Baths           .  .  84 

—     Indications  for      .  .  89 
Faradic    Battery,    Failure    to 

Work 198 

—  Current,    Regulation    and 

Measurement  of          .  .  199 

Faradization   .  .           .  .           .  .  189 

—  Indications  for      .  .           .  .  203 

—  Technique  of  .  .  .  .  202 
Fat,  Caloric  Value  of  .  .  230 
Feeding  [sea  Diet) 

Filiform  Douche         .  .           .  .  S3 

Finsen  Light  ..           ..           ..  133 

Finsen's  Rays  Compared  with 

Dowsing's         .  .           .  .  97 

Fischer  Kiefer  Nauheim  Gen- 
erator  .  .           .  .           .  .  76 

—  —  Sitz  Bath         .  .          .  .  40 
Fish,  Caloric  Value  of            .  .  232 
Fissure    of    Anus,     High-fre- 
quency Treatment  of  227 

Flatulence  Relieved  by  Milk 

Diet      .  .           .  .           .  .  271 

Fomentations  and  Poultices  69 

Food,  Caloric  Value  of          .  .  230 

—  Composition    of    Common 

Articles  of       ..  231-236 

—  General     Principles     and 

Composition  of  .  .  229 
Foods,  Relative   Digestibility 

of           . .           . .           . .  241 

Foot  Bath 36 

Foreign  Mineral  Waters  .  .  284 
Four-cell     (Schnee)     Electric 

Bath     .  .          .  .          . .  209 

Franklinization,  Era  of          .  .  158 

Franz  Josef  Water     .  .           .  .  285 

Frictional  or  Static  Electricity  213 

Friedrichshall  Water              ..  285 

Fruits,  Food  Value  of             .  .  233 

Full  Bath         47 

GAIFFE  -  D'ARSONVAL 

Electric  Installation    .  .  161 

Galen  and  the  Use'  of  Bathing  i 

Galvanic  Battery,  Faults  in  185 

—  or  Continuous  Current   .  .  161 


INDEX 


299 


Galvanism     and     Faradism, 

Historical  Summary..  158 

Galvanization,  Central           .  .  187 

—  Era  of         .  .           .  .           .  .  159 

—  General  Technique  of       .  .  186 

—  Switchboard  for  .  .  .  .  1 76 
Galvanometers  ..  ..  177 
Game,  Composition  of  .  .  231 
Gastrectasis,    Danger     of     in 

Phthisis     from     Over- 
eating . .           . .           . .  261 

Gastric  Affections,  Sinusoidal 

Current  in        . .           . .  20S 

—  Digestion,  Time  Table  for  241 

—  Dilatation,    Water    Injec- 

tions for           .  .          . .  30 

—  Disease.  Diet  in  .  .  .  .  253 
Gleet,  Psychrophore  in  .  .  33 
Glycosuria  (see  Diabetes) 

Gout,  Diet  in               .  .           .  .  25S 

—  Dowsing  Bath  in               .  .  107 

—  Fango  Mud  Bath  in         .  .  91 

—  Hydro-electric  Bath  in   .  .  212 
Grape  Cure      ..           ..           ..  275 

Greville's        Radiant        Heat 

Apparatus        . .          .  .  114 

HEMORRHOIDS,  Sitz  Bath 

for         . .          .  .          .  .  43 

Hahn's     Advocacy     of     the 

Water  Cure     .  .           .  .  2 

Half  Bath        45 

Hall,    Walker,    on    Purins    in 

Food     .  .           .  .           . .  244 

Hand  Bath 38 

Head  Bath ^8 

Head  Compress  .  .  .  .  58 
Headaches,    Foot    and    Head 

Baths  in  .  .  . . 37-39 

Health,  Diet  in          .  .           .  .  242 

Heart  Disease.  Diet  in          .  .  251 

—  Effect  of  Hydrotherapy  on  18 

—  —  —  Nauheim  Treatment 

on      .  .           .  .           . .  78 

Heat  and  Light  in  the  Treat- 
ment of  Disease         .  .  94 

—  Moist,  Dry,  and  Radiant  95 

—  Physiological  Effect  of   .  .  15 

—  Regulation,  or  Thermotaxis  1 5 

—  as  a  Therapeutic  Agent..  10 

—  Toleration  of  Exposure  to  21 

—  Unit,  Caloric  .  .  .  .  230 
Heating  and  Cooling,  Effects 

of           . .           .  .           .  .  12 

Herschell-Dean     Sinusoidal 

Current  Apparatus     .  .  206 


PAGE 

High-frequency  Currents      .  .  218 

—  —  Auto-conduction         .  .  222 

—  —  Condensation               .  .  222 

—  —  as  Counter-irritant     .  .  225 

—  —  Effect    on    Blood-pres- 

sure   . .           . .           . .  226 

—  —  the  Effleuve    .  .           .  .  223 

—  —  how  Generated            .  .  219 

—  —  Over-rated  Formerly  226 

—  —  Therapeutic  Indications  225 
Hippocrates   and   the   Use   of 

Bathing            .  .           .  .  i 

History  of  Bathing    .  .           .  .  i 

Homer's  Allusions  to  Bathing  i 

Hot-air  Baths,  Temperature  of  93 

—  Cabinet  Bath         .  .           .  .  115 

—  Steam,  and  Turkish  Baths  115 
Hovent's  Sledge  Coil  .  .  192 
Hunyadi  Janos  Water  .  .  286 
Hutchison,    R.,    on    Dietetic 

Treatment       .  .           .  .  249 

Hydro-electric  Bath  .  .           .  .  208 

—  —  Therapeutic        Indica- 

tions    .  .           .  .           .  .  212 

—  —  (whole)  .  .  .  .  211 
Hydropathic     Establishment. 

the  Ideal          .  .           .  .  28 1 

—  Establishments     and     the 

Modern  "  Cure  "         .  .  278 

—  —  Prejudices  Concerning  280 
Hydrotherapeutic  Applications, 

Basis  of             .  .           .  .  24 
Hvdrotherapv,  General  Effect 

of        " 16 

—  General  Indications          .  .  21 

—  General  Principles  of       .  .  10 

—  History  of .  .           .  .           .  .  i 

—  Physiological  Ertect  of   ..  13 

—  Popularized  in  England .  .  4 
Hypera?mia  Induced  by  Com- 
presses. .             .           •  •  57 

Hyperchlorhydria,  Diet  in  .  .  254 
Hj-pochondriasis,  Hydro-electric 

Bath  in            .  .          . .  212 

—  Milk  Cure  in          .  .          .  .  269 


TCEBag         

1  —  —  Use  of,  in  Pleurisy 

—  Collar  in  Diphtheria 
Impotence,    Psychrophore   in 
Incandescent     Electric-light 
Bath     . .  . .      V 

Induced  Currents,  Origin  of 
Induction  Coil 
Infants,  Dietary  of    .  . 
Insomnia,  Massage  for 


/  :> 
74 
74 
^l 

128 
191 
190 
246 
147 


300 


INDEX 


Internal     Administration     of 
Water  .  . 

—  Organs,  Cutaneous  Areas 

Reflexly  Associated  with 

22,     23 

—  —  Effect  of  Hydrotherapy 

on      .  . 
Intestinal      Affections,      Milk 
Cure  in 

—  —  Sinusoidal  Current  in 
Intoxicating  Beverages,   Per- 
centage of  Alcohol  in 

Irrigation,  Rectal 

—  Urethral     .  . 

—  Vaginal 
Isolation,  Need  of  Absolute  in 

Rest  Cure 

tOHANNIS  Water.. 
J     Joint  Affections,  Massage  m 

—  Compresses 
Kellogg,   Dr.    J.   H.,  and   the 

Battle  Creek  Sanitarium 
Kelvin  and  the  Galvanometer 
Kidney  Disease,  Diet  in 

—  —  Electric-light    Bath 
Kneipp  Cure  .  . 
Koumiss,  Artificial     .  . 

—  Cure 
Kuranstalten  in  Germany 

T    A  BOURBOLE  Water 
-L/     Leclanche  Cells 
Leg  Bath 
Leiter's  Tubing 
Leucocytosis,     Induced     by 

Hydrotherapy 
Leucodescent     Therapeutic 

Lamp   .  . 
Liebermeister  and  the  Cooling 

Bath  in  Typhoid 
Light  Rays,  Nature  of 

—  in     the     Treatment     of 

Disease  .  .  94, 

Lindsay,     Professor,    on    the 

Nauheim  Baths 
Linseed  Poultices 
Liver  Diseases,  Milk  Cure  in 
Luminous  Radiant  Heat 

MAN  a  Cooking  Animal .  . 
Marienbad  Waters     .  . 
Massage  Douche 

—  Effleurage 

—  Electric      .  .  .  .         149, 

—  Friction 


PAGE 

Massage  of  the  Genital  Organs, 

PAGE 

26 

etc.,  Condemned 

148 

—  History  of 

134 

—  Petrissage 

137 

.    25 

—  Practised  by  the  Blind  .  . 

13s 

—  in  Rest  Cure 

155 

20 

—  Tapotement 

138 

—  Varieties  of 

136 

269 

—  Vibration  . . 

140 

208 

Matlock,  John  Smedley  and 

5 

Mattress,  Electric  Sweating .  . 

68 

240 

Meat,  Excess  of,  in  Diet 

265 

32 

—  How  to  Cook 

237 

33 

Meats,  Composition  of 

231 

31 

Medicated  Baths 

92 

Menstrual  Disorders,  Baths  in  37-43 

154 

Metabolism,  Action  of  Light 

on          . .           .  .         122 

131 

289 

—  Effect  of  Hydrotherapy  on 

16 

147 

Metritis,  Irrigation  for 

32 

63 

Milk    in    Chronic    Bright' s 

Disease 

272 

4 

—  Cure 

269 

179 

Mineral  Waters,  Foreign 

284 

263 

]Motor  Transformers  .  . 

173 

131 

Mucous  Colitis,  Water  Injec- 

8 

tions  for 

30 

374 

Muscles,     Effect    of     Hydro- 

273 

therapy  on 

17 

8 

Mustard  Applications 

71 

—  Foot  Bath 

17 

288 

—  Sitz  Bath 

43 

163 

Myalgia,  Massage  in .  . 

148 

39 

74       AT  AUHEIM  Baths .  . 

IN  —  Fischer  Kiefer  Genera- 
17  tor  for 

—  —  Effect  on  Cardiac  Dull- 

1 1 1  ness  and  Pulse-tracing 

—  —  Indications  for 
8       —  Exercises   .  . 

122       Needle  Douche 

Neptune's  Girdle 
122       Nerve    Reflexes    and    Hydro- 
therapy 

82       Nervous  Affections,  Massage  in 

71       —  —  Hydro-electric  Bath  in 
269       —  System,  Effect  of  Hydro- 

96  tlierapy  on 

Neurasthenia,  Gastric,  Diet  in 
236       —  Milk  Cure  in 
286       —  and  the  Modern  "  Cure  " 

54       —  Sinusoidal  Currents  in     .  . 
136       Neuritis,  Fango  Mud  Baths  in 
202       Neuroses,     High-Frequency 
1 39  Currents  and  .  . 


75 
76 

78 
81 

79 
53 
63 


24 
148 


17 
255 
269 
278 
208 

90 

226 


INDEX 


HOI 


PAGE 

PAGE 

/^BESITY,  Diet  in      .  .       .  . 
\J     —  Electric-light  Bath  in 

26r> 

Pulse-tracing  after  Full  Bath 

47 

131 

—  —  —  High-Frequency 

—  ]Massage  in 

148 

Treatment 

227 

—  Salisbury  Treatment  for .  . 

265 

— Hot        and       Cold 

Oertel's     Advocacy     of     the 

Applications          i 

S,  19 

Water  Cure     .  . 

3 

—  —  —  Nauheim  Baths    .  . 

79 

Old  Age,  Value  of  Wine  in  .  . 

247 

—  —  —  Spray  Bath 

53 

Osmosis  in  relation  to  the  Ac- 

— —  —  Mchy  Douche 

55 

tion  of  Compresses     .  . 

S6 

Purins  in  Food 

244 

Oudin  Resonator 

219 

Oxidation    Stimulated    by 

p  ADIANT  Heat     .  . 

Iv     —  —  Baths,  Indication? 

96 

Water  Drinking 

29 

for 

106 

pACK,  Dry 
Jr      —  Mustard 

66 

—  —  Physiological  Action  of 

100 

72 

Rain  Douche  .  . 

52 

—  Wet            

65 

Reaction    after    Hydrothera- 

Pain,     Visceral,     Cutaneous 

peutic  Procedures 

13 

Areas  Reflexly  Associa- 

Reactive   Capacity,    Baruch's 

ted  with 

2q 

Test  for 

14 

Peat  Baths      

84 

Rectal  Injections  of  Water  .  . 

29 

Peebles     Hydropathic     Sun 

—  Irrigation  .  . 

32 

Bath 

124 

Renal  Disease,  Diet  in 

263 

Percussion  Douche    .  . 

SI 

—  —  Electric-light  Bath  in 

131 

Phlebitis,  Radiant  Heat  in  .  . 

108 

Respiration,  Effect  of  Hydro- 

Phototherapy 

122 

therapy  on 

20 

Phthisis,  Diet  in 

261 

Rest    Cure,    Indications    and 

—  High-frequency     Currents 

Principles     .  . 

152 

in 

228 

Milk  Diet  in   .  . 

270 

—  the  Koumiss  Cure  for      .  . 

273 

Rheumatism,  Dowsing  Bath  in 

107 

Physiological  Effects  of  Elec- 

—  Fango  Mud  Baths  in           89,  90 

tric-hght  Baths 

126 

—  Hydro-electric  Bath  in   .  . 

212 

—  Fango  Mud  Baths 

87 

Rheumatoid  Arthritis,  Fango 

Heat 

15 

Mud  Baths  in 

90 

—  —  —  Hydrotherapy 

13 

Radiant  Heat  in 

108 

—  —  —  Nauheim  Baths  .  . 

81 

Rheostats 

170 

Radiant  Heat 

100 

Roentgen   Rays,   Nature  and 

Sun  Baths 

125 

Use  of  .  . 

132 

—  Turkish  Baths 

121 

Rubinat  Water 

287 

Plaster,  Mustard 

72 

Ruk  Vibrator 

149 

Plunge  Bath 

46 

Poultices      (Linseed,      bread. 

0  T.  GALMIER  Water 
0     Salisbury  System 

289 

starch,  bran)  .  . 

71 

26s 

Powell,   Sir   Douglas,   on   the 

Sand  Baths     .  .           .  .            91 

124 

Nauheim  Baths 

81 

Sanitarium,  Battle  Creek     .  . 

4 

Precautions  as  to  the  taking  of 

Schade's  Theory  of  the  Wet 

Baths    .  . 

34 

Compress 

56 

Priessnitz,  \'incent.  Crisis  in- 

Schnee Electric  Bath 

209 

troduced  by 

^ 

Schott-Nauheim  Exercises   .  . 

79 

—  —  Experiments  on  Pigs 

3 

Schwalbach  Water     .  . 

288 

—  —  His    success    with    Pa- 

Sciatica. Hydro-electricity  in 

212 

tients 

4 

—  Radiant  Heat  in  .  . 

loS 

Proteids,  Caloric  Value  of    .  . 

230 

Scotch  Douche 

52 

Psvchrophore  of  Winternitz 

33 

Scoutellen  and  Hydrotherapy 

8 

Pu'llna  Water 

286 

Self-induction 

193 

Pulse,    Effect  of  Cold   Water 

Shunt,  Galvanometer 

179 

Drinking  on    .  . 

27 

Sinapisms 

71 

302 


INDEX 


Sinusoidal  Currents   .  . 

Sitz  Bath         

—  —  Indications  for 

—  —  Value  of 

—  —  Varieties  of     .  . 

Skin  Diseases,  High-frequency 
Currents    in      .  . 

—  Effect  of  Hydrotherapy 

on  Action  of  .  . 

—  Reflex     Association     with 

Internal  Organs       22,2 
Sledge  Coil  for  Faradic  Current 
Smedley,  John,  and  his  Work 
Sool  Bader  (Brine  Baths)     .  . 
Soups,    etc.,    Chemical    Com- 
position of 
Spamer's  Induction  Coil 
Spermatorrhoea,  Psychrophore 

in 
Spinal  Ice  Bag 
Starch  Poultices 
Static  Electricity 

—  —  John  Wesley  and 

—  —  Wimshurst      Machine 

for 

Steam  Cabinet  Bath  .  . 
Stimulants  (See  Alcohol). 
Stomach  Diseases,  Diet  in   .  . 

—  —  Milk  cure  in    .  . 

—  Massage  of 

Strumpell    on    the    Nauheim 

Baths 

Stupe,  Turpentine 
Sun  Baths,  Effects  and  Indica- 
tions .  . 

Indoor 

Sweating  Leg  Bath   .  . 
Switchboards 

TABES     Dorsalis,     Fango 
Mud  Baths  in  .  . 
Table  Waters 
Tea,  Abuse  and  Value  of 

—  Indian    and    China    com 

pared    .  . 
Technique   of   Baths,   Partial 

and  General    .  . 
Temperature   Chart,    Fahren 

heit  and  Centigra  e  . 

—  Effect  of  Water  Drinking 

on 

—  of  Various  Baths  .  . 
Tesla  Transforrrier 
Testicular      Neuralgia,      Psy 

chrophore  in   . . 
Tlicrmogenesis 


204 
40 
43 
43 
41 

227 
17 

3,  25 
190 

5 
92 

232 
189 

33 

74 

71 

213 

158 

213 
117 

253 
269 

143 

82 
71 

123 
124 

39 
170 


91 


Thermometric     Equivalents, 

Chart  Showing 
Thermophore,  Electric 
Thermotaxis    .  . 
Thermotherapy,  General  Prin 

ciples  of 
Throat  Compress 
Toffee,  Dietetic  Value  in  Chil 

dren 
Total  Abstinence 
Toxaemia,  Electric  Light  Bath 

in 
Transformers 
Triphase  Currents 
Trunk  Compress 
Tuberculosis,  Diet  in 

—  High-Frequency    Currents 

in 

—  Koumiss  Cure  for 
Turkish  Baths 
Turpentine  Stupe 
Typhoid,  the  Cold  Bath  in 


103 
63 


10,  94 
59 

246 
239 

131 
172 
205 
61 
261 

228 

273 
119 

71 


25s 
263 

33 


ULCER,  Gastric,  Diet  in. 
Uraemia,  Diet  in 
Urethral  Irrigation    .  . 
Uric    Acid    Diathesis,    Light 

Treatment  of  126,  131 

Effect  of  Milk  Diet  on      271 

Uterine  Congestion,  etc..  Irri- 
gation for         .  .  .  .        32 


VAGINAL      Douching      or 
Irrigation 
Valvular     Disease,     Nauheim 

Treatment  in  .  . 
Van  der  Heyden's  Use  of  Cold 

Water  in  Dysentery  . . 
Vascular  Areas,  Hydrotherapy 

and 
Vegetables,  Composition  of  .  . 
—  and  their  Food  Value 


31 

S2 


24 
232 
229 


238       Vibration  Massage,  Mechanical    149 

Vichy  Massage  Douche         .  .        55 

2^8       —  Waters       .  .  .  .  .  .      287 

Visceral  Pain,  Cutaneous  Areas 
35  Rellexly        Associated 

with      .  .  .  .  . .        25 

103       Voltmeter         ..  ..  ..      180 

Von    Ziemssen's    Work    with 
27  Galvanometers  .  .      177 

10 
220       T  X  7AGNER  Hammer  of  In- 

VV       duction   Apparatus  .  .      197 
33       Water,    Internal    Administra- 
1 3  tion  of .  .  .  .  .  .        26 


INDEX 


308 


Water      as      a      Means      of 
Conveying      Thermal 

Stimuli              .  .           .  .  lo 

—  Method  of  Prescribing    .  .  28 

—  Therapeutic  Use  of          .  .  10 

—  Thermic  Flexibility  of    .  .  10 

—  in  the  Treatment  of  Dis- 

ease      .  .           .  .           .  .  I 

Waters,  Foreign  Mineral      .  .  284 

Waters,  Saline  Purgative      . .  284 

Weight  Records  in  Rest  Cure  152 

—  Reduction  of         . .           .  .  265 
Weir  Mitchell  Treatment     ..  152 

—  —  —  Milk  in       .  .           .  .  270 
Wesley,  John,  an  advocate  of 

Hydrotherapy              .  .  2 


Wesley,  John,  and  Franklinic 

Electricity 
Wet  Compress 

—  Pack 
Whey  Cure 
Wildungen  Water 
Wimshurst  Machine  .  .  161, 
Winternitz's     Electric-light 

Bath     . . 

—  His     Valuable     Work     in 

Hydrotherapeutics 

RAY  Period  in  Electrical 
History 
—  Nature  and  Use  of     .  . 


X 


158 
56 
65 

272 

288 
213 

128 
7 


159 
132 


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